Biomechanics and clinical outcomes of various conduit configurations in valve sparing aortic root replacement.
Biomechanics and clinical outcomes of various conduit configurations in valve sparing aortic root replacement.
复制标题
保留瓣膜的主动脉根部置换术中各种管道配置的生物力学和临床结局。
DOI：
10.21037/acs-2023-avs2-0068
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发表时间：
2023-07-31
影响因子：
3.1
通讯作者：
Woo, Y. Joseph
中科院分区：
文献类型：
--
作者：
Zhu, Yuanjia;Park, Matthew H.;Pandya, Pearly K.;Stark, Charles J.;Mullis, Danielle M.;Walsh, Sabrina K.;Kim, Joo Young;Wu, Catherine A.;Baccouche, Basil M.;Lee, Seung Hyun;Baraka, Abakar S.;Joo, Hyunchel;Yajima, Shin;Elde, Stefan;Woo, Y. Joseph
关键词：
已经描述了用于保留瓣膜的主动脉根部置换术（VSARR）的几种管道配置，例如直型移植物（SG）、Valsalva移植物（VG）、抗连合折叠术（ACP）和斯坦福大学改良（SMOD）技术。之前的体外研究已经评估了导管配置对根部生物力学的影响，但是所使用的模拟冠状动脉回路不能复制天然冠状动脉的物理特性。此外，单个瓣叶的生物力学（包括扑动现象）尚不清楚。将带有冠状动脉的猪主动脉根部结扎（n=5），并使用SG、VG、ACP和SMOD进行VSARR，以在离体左心血流环路模拟器中进行评价。此外，对1993年至2022年在我们中心接受VSARR的762例患者进行了回顾性分析。进行方差分析以评价不同导管配置之间的差异，并对成对检验进行事后Tukey校正。在左冠状动脉尖（LCC）中，SG的快速瓣叶打开速度低于VG（P=0.001）和SMOD（P=0.045），在右冠状动脉尖（RCC）中，SG的快速瓣叶关闭速度低于VG（P=0.04），在RCC中，SG的相对打开力低于ACP（P=0.04）。在LCC中，基线时的扑动频率低于VG（P=0.02），VG中的扑动频率低于ACP（P=0.03）。SG组左冠状动脉平均血流高于SMOD组（P=0.02）和ACP组（P=0.05）。临床上，使用SG的手术与含窦移植物相比，主动脉阻断时间和体外循环时间短（P<0.001，<0.001）。SG表现出的血流动力学和生物力学最接近地再现了自体牙根的血流动力学和生物力学，与使用含窦移植物的修复相比，术中时间显著缩短。未来的体内确认研究以及与全面、比较性临床研究结局的相关性可能会为进一步增强修复耐久性的策略提供额外的宝贵见解。
Several conduit configurations, such as straight graft (SG), Valsalva graft (VG), anticommissural plication (ACP), and the Stanford modification (SMOD) technique, have been described for the valve-sparing aortic root replacement (VSARR) procedure. Prior ex vivo studies have evaluated the impact of conduit configurations on root biomechanics, but the mock coronary artery circuits used could not replicate the physical properties of native coronary arteries. Moreover, the individual leaflet’s biomechanics, including the fluttering phenomenon, were unclear. Porcine aortic roots with coronary arteries were explanted (n=5) and underwent VSARR using SG, VG, ACP, and SMOD for evaluation in an ex vivo left heart flow loop simulator. Additionally, 762 patients who underwent VSARR from 1993 through 2022 at our center were retrospectively reviewed. Analysis of variance was performed to evaluate differences between different conduit configurations, with post hoc Tukey’s correction for pairwise testing. SG demonstrated lower rapid leaflet opening velocity compared with VG (P=0.001) and SMOD (P=0.045) in the left coronary cusp (LCC), lower rapid leaflet closing velocity compared with VG (P=0.04) in the right coronary cusp (RCC), and lower relative opening force compared with ACP (P=0.04) in the RCC. The flutter frequency was lower in baseline compared with VG (P=0.02) and in VG compared with ACP (P=0.03) in the LCC. Left coronary artery mean flow was higher in SG compared with SMOD (P=0.02) and ACP (P=0.05). Clinically, operations using SG compared with sinus-containing graft was associated with shorter aortic cross-clamp and cardiopulmonary bypass time (P<0.001, <0.001). SG demonstrated hemodynamics and biomechanics most closely recapitulating those from the native root with significantly shorter intraoperative times compared with repair using sinus-containing graft. Future in vivo validation studies as well as correlation with comprehensive, comparative clinical study outcomes may provide additional invaluable insights regarding strategies to further enhance repair durability.
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影响因子：
--
作者：
Galea, Nicola;Piatti, Filippo;Gaudino, Mario
通讯作者：
Gaudino, Mario
影响因子：
3.4
作者：
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通讯作者：
El-Hamamsy, Ismail
DOI：
10.1016/j.jtcvs.2018.10.145
发表时间：
2019-08-01
影响因子：
6
作者：
Paulsen, Michael J.;Kasinpila, Patpilai;Woo, Y. Joseph
通讯作者：
Woo, Y. Joseph
影响因子：
3.8
作者：
Moore, Brandon L.;Dasi, Lakshmi Prasad
通讯作者：
Dasi, Lakshmi Prasad
影响因子：
4.6
作者：
Beckmann, Erik;Leone, Alessandro;Pacini, Davide
通讯作者：
Pacini, Davide