Bioengineering Group, Ri.MED Foundation, Palermo, Italy.
School of Medicine and Surgery, University of Palermo, Palermo, Italy.
Eur J Cardiothorac Surg. 2023 Mar 1;63(3). doi: 10.1093/ejcts/ezad040.
Valve-sparing procedures are surgical techniques allowing to restore adequate function of the native aortic valve by replacing the dysfunctional ascending aorta with a prosthetic conduit. A number of techniques are currently used, such as Yacoub's remodelling and David's reimplantation, based on a regular straight conduit. More recently, the De Paulis proposed the use of bulging conduits to reconstruct the shape of the Valsalva sinuses. This work investigates the impact of the valve-sparing technique on the aortic valve function.
The performance of 3 porcine aortic roots (Medtronic Freestyle™) was assessed in a cardiovascular pulse duplicator before and after performing 3 alternative valve-sparing procedures: David's reimplantation, Yacoub's remodelling and De Paulis' reimplantation.
The porcine aortic roots, representative of the healthy native configuration, were characterized by the highest efficiency, with a mean energetic dissipation under normal operating conditions of 26 mJ. David's and Yacoub's techniques resulted in significantly lower performance (with mean energetic loss of about 70 mJ for both cases). The De Paulis' procedure exhibited intermediate behaviour, with superior systolic performance and valve dynamics similar to the native case, and a mean energetic loss of 38 mJ.
The dynamics and performance after valve-sparing strongly depend on the adopted technique, with the use of conduits replicating the presence of Valsalva sinuses restoring more physiological conditions.
瓣膜保留手术是一种通过用人工管道替换功能失调的升主动脉来恢复原生主动脉瓣正常功能的外科技术。目前有许多技术，如 Yacoub 重塑和 David 再植入，都是基于常规直管。最近，De Paulis 提出使用膨出的管道来重建 Valsalva 窦的形状。这项工作研究了瓣膜保留技术对主动脉瓣功能的影响。
在心血管脉动复制器中评估了 3 个猪主动脉根部（美敦力 Freestyle™）在进行 3 种替代瓣膜保留手术前后的性能：David 再植入、Yacoub 重塑和 De Paulis 再植入。
具有健康原生结构代表性的猪主动脉根部的效率最高，在正常工作条件下的平均能量耗散为 26mJ。David 和 Yacoub 的技术导致性能显著降低（两种情况下的平均能量损失约为 70mJ）。De Paulis 手术表现出中间行为，具有更好的收缩期性能和与原生病例相似的瓣膜动力学，平均能量损失为 38mJ。
瓣膜保留手术后的动力学和性能强烈取决于所采用的技术，使用复制 Valsalva 窦存在的管道可以恢复更生理的条件。
