Benhassen Leila Louise, Ropcke Diana Mathilde, Sharghbin Mona, Lading Troels, Skov Jens Kæstel, Tjørnild Marcell Juan, Poulsen Karen Bagger, Bechsgaard Tommy, Skov Søren Nielsen, Nielsen Sten Lyager, Hasenkam John Michael
Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Ann Cardiothorac Surg. 2019 May;8(3):342-350. doi: 10.21037/acs.2019.04.02.
A subvalvular annuloplasty is often used for aortic valve repair in patients with isolated aortic regurgitation with aortic annulus dilatation. Our aim was to characterize and compare annulus geometry and dynamics of the Dacron ring and suture annuloplasty and compare it with the native aortic annulus under standardized conditions.
We randomized 29 pigs of 80 kg into a Dacron ring group, a suture annuloplasty group and a native control group. The assessment was performed using sonomicrometry crystals for evaluation of dynamic geometry, and pressure measurements and echocardiography to evaluate valve performance.
Aortic annulus area (AAA) was significantly reduced in the Dacron and Suture group compared with the Native group. Expansibility was similar and within normal physiologic limits in all three groups (Native: 12%±7%; Dacron: 11%±3%; Suture: 10%±4%). The largest segmental expansion was observed at the right coronary sinus (RC) in the Native and Dacron group but in the Suture group there was no significant difference between segments. The aortic annulus was primarily oval in systole and became more circular in diastole in the Native and Dacron group, however, in the Suture group, the sphericity remained relatively unchanged throughout the cardiac cycle.
This study is the first to describe and compare detailed segmental geometry of the Dacron ring and suture annuloplasty in a standardized porcine model. The two annuloplasties effectively downsized the aortic annulus, while expansibility was maintained. Each annuloplasty had its own geometrical characteristics, but the Dacron ring was more similar to the native aortic annulus than the suture annuloplasty. This study suggests that the Dacron ring offers a more physiological and standardized support by mimicking the geometry and dynamics of the native aortic annulus and thus is a preferable choice over the suture annuloplasty for valve-sparing aortic root procedures.
对于单纯主动脉瓣反流合并主动脉瓣环扩张的患者，瓣下环缩术常用于主动脉瓣修复。我们的目的是在标准化条件下，对涤纶环和缝线环缩术的瓣环几何形状及动力学特征进行描述和比较，并与天然主动脉瓣环进行对比。
我们将29头体重80千克的猪随机分为涤纶环组、缝线环缩术组和天然对照组。使用超声测微晶体进行评估以评价动态几何形状，并通过压力测量和超声心动图来评估瓣膜功能。
与天然组相比，涤纶组和缝线组的主动脉瓣环面积（AAA）显著减小。三组的扩张性相似且在正常生理范围内（天然组：12%±7%；涤纶组：11%±3%；缝线组：10%±4%）。天然组和涤纶组在右冠状动脉窦（RC）处观察到最大节段性扩张，但缝线组各节段之间无显著差异。天然组和涤纶组中，主动脉瓣环在收缩期主要呈椭圆形，舒张期变得更圆，然而，缝线组在整个心动周期中球形度相对保持不变。
本研究首次在标准化猪模型中描述和比较了涤纶环和缝线环缩术的详细节段几何形状。两种环缩术均有效减小了主动脉瓣环大小，同时维持了扩张性。每种环缩术都有其自身的几何特征，但涤纶环比缝线环缩术更类似于天然主动脉瓣环。本研究表明，涤纶环通过模拟天然主动脉瓣环的几何形状和动力学提供了更符合生理且标准化的支撑，因此在保留瓣膜的主动脉根部手术中，是比缝线环缩术更优的选择。
