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. 2023 May 2;63(5). doi: 10.1093/ejcts/ezad164.
For patients with isolated aortic regurgitation, a double sub- and supravalvular annuloplasty has been shown to reduce recurrent aortic regurgitation after aortic valve repair compared with a single subvalvular annuloplasty. The objective of this study was to compare the geometrical and dynamic properties of single- and double-ring annuloplasties in an in vitro model.
Eighteen aortic roots from 80 kg pigs were randomized into a control, single-ring and double-ring group. Experiments were conducted in a pulsatile in vitro model. Hydrodynamics, radial force measurements at annular and sinotubular level and 2D echographic imaging were obtained.
Both the single- and double-ring annuloplasties downsized the aortic annulus and sinotubular junction (STJ) significantly and increased the coaptation height. The double-ring annuloplasty showed an additional significant increase in coaptation height compared with the single ring [8.5 (0.9)-9.8 (0.8) mm, P < 0.01]. The single-ring annuloplasty reduced radial forces at both levels, whereas the double-ring annuloplasty showed the greatest force reduction of the STJ.
By treating the whole functional aortic annulus, encompassing both the aortic annulus and the STJ, a greater force reduction is observed. A subvalvular annuloplasty alone is efficient in reducing aortic annulus diameter and increasing coaptation height, however, by treating the STJ as well, an additional effect is observed on coaptation height, creating a more efficient stabilization. Reduction of annular force-distensibility ratio with the double-ring annuloplasty compared with the native controls indicates a sustained stabilizing effect.
对于孤立性主动脉瓣反流患者，与单一瓣下环成形术相比，双瓣下和瓣上成形术已被证明可降低主动脉瓣修复后的主动脉瓣反流复发率。本研究的目的是在体外模型中比较单环和双环成形术的几何和动力特性。
将 80kg 猪的 18 个主动脉根部随机分为对照组、单环组和双环组。在脉动式体外模型中进行实验。测量环形和窦管交界处（STJ）的流体动力学、径向力以及二维超声心动图成像。
单环和双环成形术均显著缩小了主动脉瓣环和窦管交界处（STJ）的大小，并增加了对合高度。与单环相比，双环成形术显示出更大的对合高度增加[8.5（0.9）-9.8（0.8）mm，P<0.01]。单环成形术降低了两个水平的径向力，而双环成形术降低了 STJ 的最大径向力。
通过治疗整个功能性主动脉瓣环，包括主动脉瓣环和 STJ，可以观察到更大的力降低。单纯的瓣下环成形术在缩小主动脉瓣环直径和增加对合高度方面是有效的，然而，通过同时治疗 STJ，还可以观察到对合高度的额外效果，从而实现更有效的稳定。与天然对照相比，双环成形术降低了环形力扩张率，表明其具有持续的稳定作用。
