Department of Engineering, Faculty of Science and Technology, Aarhus University, Aarhus N, Denmark.
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.
Interact Cardiovasc Thorac Surg. 2019 Jan 1;28(1):112-119. doi: 10.1093/icvts/ivy187.
Understanding the biomechanical impact of aortic valve-sparing techniques is important in an era in which surgical techniques are developing and are increasingly being used based on biomechanical understanding that is essential in the refining of existing techniques. The objective of this study was to describe how the valve-sparing remodelling (Yacoub) and reimplantation (David Type-1) techniques affect the biomechanics of the native aortic root in terms of force distribution and geometrical changes.
Two force transducers were implanted into 22 pigs, randomized to 1 of 3 groups (David = 7, native = 7 and Yacoub = 8) along with 11 sonomicrometry crystals and 2 pressure catheters. Force and geometry data were combined to obtain the local structural stiffness in different segments of the aortic root.
The radial structural stiffness was not different between groups (P = 0.064) at the annular level; however, the David technique seemed to stabilize the aortic annulus more than the Yacoub technique. In the sinotubular junction, the native group was more compliant (P = 0.036) with the right-left coronary segment than the intervention groups. Overall, the native aortic root appeared to be more dynamic at both the annular level and the sinotubular junction than both intervention groups.
In conclusion, the David procedure may stabilize the aortic annulus more than the Yacoub procedure, whereas the leaflet opening area was larger in the latter (P = 0.030). No difference (P = 0.309) was found in valve-opening delay between groups. The 2 interventions show similar characteristics at the sinotubular junction, whereas the David technique seemed more restrictive at the annular level than the Yacoub technique.
在外科技术不断发展并基于对生物力学理解的基础上日益被应用的时代，理解主动脉瓣保留技术的生物力学影响非常重要。本研究的目的是描述瓣膜保留修复（Yacoub）和再植入（David Type-1）技术如何影响原生主动脉根部的生物力学，包括力的分布和几何变化。
将两个力传感器植入 22 头猪中，随机分为 3 组（David = 7，原生 = 7，Yacoub = 8），并植入 11 个声纳微测仪晶体和 2 个压力导管。力和几何数据相结合，以获得主动脉根部不同节段的局部结构刚度。
各组在瓣环水平的径向结构刚度无差异（P = 0.064）；然而，David 技术似乎比 Yacoub 技术更能稳定主动脉瓣环。在窦管交界处，原生组比干预组在左右冠状动脉节段更具顺应性（P = 0.036）。总体而言，原生主动脉根部在瓣环水平和窦管交界处都比两组干预组更具动态性。
总之，David 术式可能比 Yacoub 术式更能稳定主动脉瓣环，而后者的瓣叶开口面积更大（P = 0.030）。各组间的瓣膜开放延迟无差异（P = 0.309）。两种干预措施在窦管交界处具有相似的特征，而 David 术式在瓣环水平的限制作用似乎比 Yacoub 术式更强。
