Aortic root geometry following valve-sparing root replacement with reimplantation or remodeling: Experimental investigation under static continuous pressure
Aortic root geometry following valve-sparing root replacement with reimplantation or remodeling: Experimental investigation under static continuous pressure
复制标题
保留瓣膜根部置换再植入或重塑后的主动脉根部几何形状：静态连续压力下的实验研究
DOI：
10.1007/s10047-020-01242-4
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发表时间：
2020
期刊：
影响因子：
1.3
通讯作者：
K. Iwasaki
中科院分区：
文献类型：
--
作者：
K. Sasaki;T. Kunihara;H. Kasegawa;M. Seki;H. Seki;J. Takada;S. Sasuga;R. Kumasawa;M. Umezu;K. Iwasaki
与各种保留瓣膜根部置换（VSRR）技术相关的主动脉根部几何形状的差异尚未完全了解。我们通过开发体外测试装置评估了当前 VSRR 技术的根配置。每个模型使用六颗新鲜猪心。主动脉根部重塑对照组涉及升主动脉置换和窦管连接部 (STJ) 直径减小 (C1)。主动脉瓣再植入对照组仅更换升主动脉（C2）。 VSRR 包括不进行瓣环成形术 (RM) 或进行瓣环成形术 (RM + A) 的重塑，以及使用管 (RI) 或手工制作的新 Valsalva 移植物 (RI + V) 的再植入。使用超声心动图研究了每个模型对 80 和 120 mmHg 闭合液压的响应的牙根几何形状。在 VSRR 模型中，RM 产生了最大的主动脉心室交界处 (AVJ)，这与非 VSRR 模型中的类似[平均 AVJ 直径 (mm) 在 80 mmHg； RM = 25.1 ± 1.5，RM + A = 20.9 ± 0.7，RI = 20.7 ± 0.9，RI + V = 20.8 ± 0.4]。 RI + V 产生最大的 Valsalva 尺寸和最大的 Valsalva/AVJ 比率，与对照组相似[80 mmHg 时的平均 Valsalva 直径 (mm)； RM = 28.4 ± 1.4，RM + A = 25.8 ± 1.3，RI = 23.6 ± 1.0，RI + V = 30.5 ± 0.8， Valsalva/AVJ 为 80 mmHg； RM = 1.14 ± 0.06，RM + A = 1.24 ± 0.06，RI = 1.15 ± 0.06，RI + V = 1.47 ± 0.05]。 RM + A (22.4± 1.2 mm) 在 80 mmHg 下的 STJ 直径在数值上小于 RM (24.8± 2.3 mm,p= 0.11)。手术之间的 AVJ、Valsalva 或 STJ 扩张性或椭圆度没有显着差异。目前的修改，包括在新 Valsalva 移植物中进行重塑或再植入的瓣环成形术，产生接近生理的牙根几何形状。
The differences in aortic root geometry associated with various valve-sparing root replacement (VSRR) techniques have not fully been understood. We evaluated the root configuration of current VSRR techniques by developing in vitro test apparatus. Six fresh porcine hearts were used for each model. The aortic root remodeling control group involved replacement of the ascending aorta with diameter reduction of sino-tubular junction (STJ) (C1). The aortic valve reimplantation control group involved replacement of the ascending aorta alone (C2). VSRR included remodeling without (RM) or with annuloplasty (RM + A) and reimplantation with a tube (RI) or a handmade neo-Valsalva graft (RI + V). The root geometry of each model in response to closing hydraulic pressures of 80 and 120 mmHg was investigated using echocardiography. Among the VSRR models, RM yielded the largest aorto-ventricular junction (AVJ), which was similar to those in non-VSRR models [mean AVJ diameter (mm) at 80 mmHg; RM = 25.1 ± 1.5, RM + A = 20.9 ± 0.7, RI = 20.7 ± 0.9, RI + V = 20.8 ± 0.4]. RI + V yielded the largest Valsalva size and largest ratio of Valsalva/AVJ, which was similar to the control group [mean Valsalva diameter (mm) at 80 mmHg; RM = 28.4 ± 1.4, RM + A = 25.8 ± 1.3, RI = 23.6 ± 1.0, RI + V = 30.5 ± 0.8, ratio of Valsalva/AVJ at 80 mmHg; RM = 1.14 ± 0.06, RM + A = 1.24 ± 0.06, RI = 1.15 ± 0.06, RI + V = 1.47 ± 0.05]. The STJ diameter at 80 mmHg was numerically smaller with RM + A (22.4 ± 1.2 mm) than with RM (24.8 ± 2.3 mm,p= 0.11). There were no significant differences in AVJ, Valsalva, or STJ distensibility or ellipticity between procedures. Current modifications, including annuloplasty for remodeling or reimplantation in the setting of neo-Valsalva graft, yield near-physiological root geometries.