Nappi Francesco, Avtaar Singh Sanjeet Singh, Acar Christophe
Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, Paris, France.
Department of Cardiac Surgery Golden Jubilee National Hospital, Glasgow, UK.
Transl Pediatr. 2020 Apr;9(2):137-143. doi: 10.21037/tp.2020.03.02.
It has been few years since the preliminary translational research study on mechanics performance of autologous pulmonary tissue were published to circumvent complication relies to SVD. Several studies reported the modification of pulmonary native autograft root subjected to dynamic stress strain in long-term outcomes of aortic valve replacement. Our multidisciplinary research team firstly describe the weave relationship between stress-strain, growth and remodelling in an experimental model of Ross Operation. From a biomechanical point of view, the rapid absorption of polydioxanone constituting the internal part of the device may limit the potential negative effect of excessive stretching and improvement of steeper curve in the circumferential response. Improvement of longitudinal stretching of pulmonary autograft by external component of device are indicative of auxetic effect of e-PTFE. Successful reinforcement with semiresorbable device can also be favourable to pulmonary autograft function in growing patients needing to match somatic growth. The attendant decrease in PA expansion and the preserved features of the valve leaflets enhances durability of Ross operation. Strengthening of the distal pulmonary root anastomosis using external reinforcement, modifying the ascending phase of the circumferential stress curve, might be advisable as previously described. PA is an ideal substitute for aortic valve replacement not only in Mr. Ross's dreams but also from the biomechanical point of view.
自从关于自体肺组织力学性能的初步转化研究发表以来，已经过去了几年，该研究旨在规避与SVD相关的并发症。几项研究报告了在主动脉瓣置换的长期结果中，对接受动态应力应变的肺自体移植根部进行的改良。我们的多学科研究团队首次在Ross手术的实验模型中描述了应力应变、生长和重塑之间的交织关系。从生物力学的角度来看，构成装置内部部分的聚二氧六环酮的快速吸收可能会限制过度拉伸的潜在负面影响，并改善圆周反应中更陡峭曲线的情况。装置外部组件对肺自体移植纵向拉伸的改善表明了e-PTFE的负泊松比效应。对于需要匹配身体生长的成长中的患者，使用半可吸收装置成功加固也可能有利于肺自体移植功能。肺动脉扩张的相应减少以及瓣膜小叶的保留特征提高了Ross手术的耐久性。如前所述，使用外部加固来加强远端肺动脉根部吻合术，改变圆周应力曲线的上升阶段，可能是可取的。肺动脉不仅在罗斯先生的梦想中，而且从生物力学的角度来看，都是主动脉瓣置换的理想替代品。
