Impact of graft size and resuspension level of the commissures on aortic insufficiency after reimplantation of the aortic valve
Impact of graft size and resuspension level of the commissures on aortic insufficiency after reimplantation of the aortic valve
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DOI：
10.1055/s-2007-965382
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发表时间：
2007-09-01
影响因子：
1.5
通讯作者：
Roth, P.
中科院分区：
文献类型：
--
作者：
Babin-Ebell, J.;De Vivo, F.;Roth, P.
背景：除了移植物的大小之外，连合的重新悬浮被认为对于保留瓣膜的主动脉根部置换手术中的瓣膜功能也很重要。本研究描述了逐步降低移植物内连合固定水平以及逐步减小移植物尺寸对瓣膜关闭不全的影响。方法：将猪主动脉瓣重新植入管状移植物中，逐步降低连合高度。在第二个系列的实验中，移植物的直径减少了30%和50%。结果：连合高度减少10%和20%导致回流水显着增加。使用同种移植物准备的标准，可以容忍 10% 的减少，但不能容忍 20% 的减少。瓣膜的接合水平变得越来越低，表明晚期瓣膜功能不全的风险更高。假体直径减小 30% 和 50% 不会导致瓣膜关闭不全，但会降低接合水平。结论：移植物内连合的重新悬浮对早期失败率的影响比移植物尺寸的选择更重要。
Background: In addition to the size of the graft, the resuspension of the commissures has been described as important for valve function in valve-sparing aortic root replacement procedures. This study describes the influence of a stepwise reduction of the fixation level of the commissures within the graft as well as a stepwise reduction of graft size on valve insufficiency.Method: Porcine aortic valves were reimplanted into a tubular graft and the height of the commissures was reduced in a stepwise manner. In a second series of experiments, the diameter of the grafts was reduced by 30% and 50%.Results: A reduction of the commissure heights by 10% and 20% caused a significant increase in reflux water. Using the criteria of homograft preparation, a 10%, but not a 20%, reduction was tolerated. The coaptation level of the valve became increasingly lower, indicating a higher risk for late valve incompetence. A reduction of the prosthesis diameter by 30% and 50% did not result in insufficiency of the valve but it lowered the coaptation level.Conclusion: Resuspension of the commissures within the graft has a more important impact on early failure rates than the choice of graft size.