Changes of Aortic Flow Patterns detected by 4D- Flow- Magnetic Resonance Imaging after Trileaflet Reconstruction of the Aortic Valve with Autologous Pericardium compared to Prosthetic Valve Replacement with Biological Prosthesis

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Trileaflet reconstruction of the aortic valve with autologous pericardium (TriRec) is a new treatment option for diseased aortic valves and offers benefits compared to conventional valve replacement. At the moment no prospective randomized trials evaluating the role of the TriRec procedure are available and factors contributing to long- term durability are unknown. In a prospective randomized trial, we want to compare aortic flow patterns using 4D- Flow- Magnetic Resonance Imaging (MRI) in patients either after the TriRec procedure or biological prosthetic valve replacement. In healthy subjects with tricuspid aortic valves, flow patterns in the ascending aorta, examined with 4D- Flow- MRI, show nearly laminar flow and no outflow obstruction. In contrast, helical flow patterns, turbulences and increased flow velocities are observed in diseased valves and also after valve replacement with mechanical or biological prostheses. These helical flow patterns seem to not only influence aortic wall remodeling but may contribute to structural valve dysfunction of biological prosthesis. We hypothesize that after the TriRec procedure flow patterns will be more physiological than after biological aortic valve replacement. The results can contribute to understanding mechanisms influencing long- term durability of the TriRec valve and help determine the role of this novel technique for the treatment of aortic valve disease.