不同类型保留主动脉瓣手术（重塑、窦部假体植入和再植入）的体外流体动力学、瓣叶弯曲变形和根部扩张性。
In vitro hydrodynamics, cusp-bending deformation, and root distensibility for different types of aortic valve-sparing operations: remodeling, sinus prosthesis, and reimplantation.
作者信息
Erasmi Armin, Sievers Hans-H, Scharfschwerdt Michael, Eckel Thorsten, Misfeld Martin
机构信息
Department of Cardiac Surgery, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
出版信息
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1044-9. doi: 10.1016/j.jtcvs.2005.06.005.
OBJECTIVE
Preserving aortic valve cusps during operations for aortic root pathology theoretically offers several advantages over alternative prosthetic valve-bearing conduits. Functional properties of different valve-sparing techniques under defined conditions are not well studied.
METHODS
Fresh porcine aortic roots were investigated in a pulsatile flow simulator, either native root or after different types of valve-sparing procedures (remodeling, sinus prosthesis, and reimplantation). Functional parameters, such as transvalvular pressure gradient, closing volume, cusp-bending deformation, and distensibility at different levels of the root were analyzed.
RESULTS
The mean pressure gradient was highest in reimplantation techniques (8.4 +/- 1.8 mm Hg) compared with sinus prostheses (7.2 +/- 0.9 mm Hg, P = .01) and remodeling techniques (6.8 +/- 1.0 mm Hg, P = .002), mirror imaging the closing volume (reimplantation, 1.5 +/- 0.4 mL; sinus prostheses, 2.3 +/- 0.7 mL [P < .001]; remodeling, 3.4 +/- 1.1 mL [P < .001]). Bending deformation indices increased significantly from remodeling (0.45 +/- 0.05) and sinus prostheses (0.58 +/- 0.06) to reimplantation techniques (0.73 +/- 0.09). Dynamic changes in area of all techniques were decreased at the sinotubular junction and the commissural and sinus levels when compared with those seen in native roots but increased at the annular level for techniques with unfixed annulus (remodeling and modified sinus prosthesis).
CONCLUSIONS
In vitro the various aortic valve-sparing operations differed characteristically in their ability to spare valve function, none of them completely meeting native valve behavior. The remodeling techniques exhibited valve dynamics closest to those of the native aortic root. The more the aortic valve is fixed with noncompliant prosthetic material, the more the native root dynamics are impaired.
目的
在主动脉根部病变手术中保留主动脉瓣叶理论上比使用替代的带人工瓣膜管道具有多个优势。不同瓣膜保留技术在特定条件下的功能特性尚未得到充分研究。
方法
在脉动流模拟器中研究新鲜猪主动脉根部，包括天然根部或经过不同类型的瓣膜保留手术（重塑、窦部假体和再植入）后的根部。分析了不同根部水平的功能参数，如跨瓣压差、关闭容积、瓣叶弯曲变形和扩张性。
结果
与窦部假体（7.2±0.9 mmHg，P = 0.01）和重塑技术（6.8±1.0 mmHg，P = 0.002）相比，再植入技术的平均压差最高（8.4±1.8 mmHg），关闭容积情况与之相反（再植入，1.5±0.4 mL；窦部假体，2.3±0.7 mL [P < 0.001]；重塑，3.4±1.1 mL [P < 0.总压差最高（8.4±1.8 mmHg），而窦部假体组为（7.2±0.9 mmHg，P = 0.01），重塑技术组为（6.8±1.0 mmHg，P = 0.002），关闭容积情况与之相反（再植入组为1.5±0.4 mL；窦部假体组为2.3±0.7 mL [P < 0.001]；重塑组为3.4±1.1 mL [P < 0.001]）。从重塑（0.45±0.05）和窦部假体（0.58±0.06）到再植入技术，弯曲变形指数显著增加（0.73±0.09）。与天然根部相比，所有技术在窦管交界处、瓣叶联合处和窦部水平的面积动态变化均减小，但对于瓣环未固定的技术（重塑和改良窦部假体），在瓣环水平增加。
结论
在体外，各种主动脉瓣保留手术在保留瓣膜功能的能力上具有特征性差异，没有一种完全符合天然瓣膜的行为。重塑技术表现出最接近天然主动脉根部的瓣膜动力学。主动脉瓣与非顺应性假体材料固定得越多，天然根部动力学受损越严重。 001]）。从重塑（0.45±0.05）和窦部假体（0.58±0.06）到再植入技术，弯曲变形指数显著增加（0.73±0.09）。与天然根部相比，所有技术在窦管交界处、瓣叶联合处和窦部水平的面积动态变化均减小，但对于瓣环未固定的技术（重塑和改良窦部假体），在瓣环水平增加。
结论
在体外，各种主动脉瓣保留手术在保留瓣膜功能的能力上具有特征性差异，没有一种完全符合天然瓣膜的行为。重塑技术表现出最接近天然主动脉根部的瓣膜动力学。主动脉瓣与非顺应性假体材料固定得越多，天然根部动力学受损越严重。
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