Department of Cardiac Surgery, European Hospital, Rome, Italy.
Division of Cardiac Surgery, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
Surg Technol Int. 2021 May 20;38:271-277. doi: 10.52198/21.STI.38.CV1390.
In the original pre-formed Valsalva graft, the skirt is the defining feature. It is a self-expanding portion, obtained by 90° rotation of the Dacron fabric corrugation with respect to the rest of the graft. Due to this manufacturing feature, the skirt length is equal to the graft diameter and, once pressurized, it expands by 25-30% (up to 10 mm) from the nominal size. Proximal to this bulged portion, a small collar completes the prosthesis. By virtue of this anatomical design, the Valsalva graft is recommended for most aortic root surgeries including valve-sparing and Bentall procedures. The skirt, by recreating the pseudo-sinuses, represents the key feature of the graft when used for aortic valve-sparing procedures (remodeling and reimplantation). However, in the Bentall procedure, the graft collar is an important feature because it is useful to attach the Valsalva graft to the valve prosthesis sewing ring when making a valved conduit. Moreover, once the graft is pressurized, the whole volume of the skirt better accommodates the struts and the leaflets of biological and mechanical prostheses. Furthermore, the expanded skirt reduces the distance and the tension on the coronary button anastomosis, increasing safety and possibly reducing complication rates. This review demonstrates the versatility of the Valsalva graft in various scenarios of aortic root surgery, with special emphasis on different uses of the skirt and the collar.
在原始的预成型瓦尔萨尔瓦移植物中，裙边是其主要特征。它是一个自扩张部分，通过将涤纶织物波纹相对于移植物的其余部分旋转 90°获得。由于这种制造特征，裙边长度等于移植物直径，并且在加压后，其尺寸从标称尺寸扩大 25-30%（最大可达 10 毫米）。在这个凸起部分的近端，一个小领完成了假体。由于这种解剖设计，瓦尔萨尔瓦移植物推荐用于大多数主动脉根部手术，包括瓣膜保留和 Bentall 手术。裙边通过重建假性窦，代表了移植物用于主动脉瓣保留手术（重塑和再植入）的关键特征。然而，在 Bentall 手术中，移植物领圈是一个重要特征，因为在制作带瓣管道时，它有助于将瓦尔萨尔瓦移植物连接到瓣膜假体缝合环上。此外，一旦移植物加压，整个裙边体积可以更好地容纳生物和机械假体的支柱和瓣叶。此外，扩张的裙边减少了冠状动脉钮扣吻合的距离和张力，提高了安全性并可能降低并发症发生率。本综述展示了瓦尔萨尔瓦移植物在各种主动脉根部手术场景中的多功能性，特别强调了裙边和领圈的不同用途。
