The Thoracic and cardiovascular surgeon · 2007
Impact of graft size and resuspension level of the commissures on aortic insufficiency after reimplantation of the aortic valve.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Babin-Ebell J, De Vivo F, Vogt P R, Roth P
Аннотация
BACKGROUND: In addition to the size of the graft, the resuspension of the commissures has been described as important for valve function in valve-sparing aortic root replacement procedures. This study describes the influence of a stepwise reduction of the fixation level of the commissures within the graft as well as a stepwise reduction of graft size on valve insufficiency.
METHOD: Porcine aortic valves were reimplanted into a tubular graft and the height of the commissures was reduced in a stepwise manner. In a second series of experiments, the diameter of the grafts was reduced by 30 % and 50 %.
RESULTS: A reduction of the commissure heights by 10 % and 20 % caused a significant increase in reflux water. Using the criteria of homograft preparation, a 10 %, but not a 20 %, reduction was tolerated. The coaptation level of the valve became increasingly lower, indicating a higher risk for late valve incompetence. A reduction of the prosthesis diameter by 30 % and 50 % did not result in insufficiency of the valve but it lowered the coaptation level.
CONCLUSION: Resuspension of the commissures within the graft has a more important impact on early failure rates than the choice of graft size.
METHOD: Porcine aortic valves were reimplanted into a tubular graft and the height of the commissures was reduced in a stepwise manner. In a second series of experiments, the diameter of the grafts was reduced by 30 % and 50 %.
RESULTS: A reduction of the commissure heights by 10 % and 20 % caused a significant increase in reflux water. Using the criteria of homograft preparation, a 10 %, but not a 20 %, reduction was tolerated. The coaptation level of the valve became increasingly lower, indicating a higher risk for late valve incompetence. A reduction of the prosthesis diameter by 30 % and 50 % did not result in insufficiency of the valve but it lowered the coaptation level.
CONCLUSION: Resuspension of the commissures within the graft has a more important impact on early failure rates than the choice of graft size.