Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Eur J Cardiothorac Surg. 2020 Jun 1;57(6):1210-1217. doi: 10.1093/ejcts/ezaa001.
Aortic valve repair procedures for the treatment of isolated aortic valve insufficiency may be improved by stabilizing the functional aortic annulus using a double annuloplasty ring at the aortic annulus and sinotubular junction (STJ). The objective of this study was to compare the geometrical changes and aortic root stress distribution when using a single subvalvular ring and a double sub- and supravalvular ring in vivo.
Both the single- and double-ring procedures were performed successively in nine 80-kg pigs. Measurements were performed intraoperatively using sonomicrometry crystals in the aortic root to evaluate geometrical changes and annular and STJ force transducers measuring the segmental radial stress distribution.
The total force in the STJ was significantly reduced after the double-ring procedure from 1.7 ± 0.6 to 0.04 ± 1.1 N (P = 0.001). The double-ring procedure significantly reduced the STJ area from 234.8 ± 37.6 to 147.5 ± 31.8 mm2 (P = 0.001) and expansibility from 17 ± 6% to 8 ± 3% (P = 0.001). With the single-ring procedure, the STJ shape was circular but became more oval with the double-ring procedure. The double-ring procedure did not affect stress distribution or geometry in the aortic annulus.
The double-ring procedure stabilized the whole aortic root by reducing radial stress distribution in the STJ more efficiently than the single-ring procedure. Both area and expansibility were reduced with the double-ring procedure. These results confirm the importance of addressing the entire functional aortic annulus for optimal aortic valve repair procedures.
在治疗孤立性主动脉瓣关闭不全时，通过在主动脉瓣环和窦管交界（STJ）处使用双瓣环稳定功能性主动脉瓣环，可改善主动脉瓣修复术。本研究旨在比较在体内使用单瓣下环和双瓣下及瓣上环时的几何形状变化和主动脉根部的应力分布。
在 9 头 80kg 的猪中先后完成了单环和双环手术。术中使用超声心动图晶体检测量主动脉根部的几何形状变化，并使用环形和 STJ 力换能器测量节段径向应力分布来评估环形和 STJ 力。
双环手术后，STJ 的总力从 1.7±0.6 降至 0.04±1.1N（P=0.001），显著降低。双环手术使 STJ 面积从 234.8±37.6 降至 147.5±31.8mm2（P=0.001），扩张性从 17±6%降至 8±3%（P=0.001）。单环手术时，STJ 的形状为圆形，而双环手术后则更呈椭圆形。单环手术不会影响主动脉瓣环的应力分布或几何形状。
与单环手术相比，双环手术通过更有效地降低 STJ 处的径向应力分布来稳定整个主动脉根部。双环手术可减少 STJ 的面积和扩张性。这些结果证实了在进行优化的主动脉瓣修复手术时，需要解决整个功能性主动脉瓣环的重要性。
