Altered stresses and dynamics after single and double annuloplasty ring for aortic valve repair. (7th February 2020)

• Record Type: Journal Article
• Authors: Benhassen, Leila Louise; Hedensted, Jacob Hesselby; Sharghbin, Mona; Skov, Søren Nielsen; Carlson Hanse, Lisa; Tjørnild, Marcell Juan; Bechsgaard, Tommy; Ropcke, Diana Mathilde; Nielsen, Sten Lyager; Hasenkam, John Michael
• Is Part Of: European journal of cardio-thoracic surgery. Volume 57:Number 6(2020)
• Page Start: 1210
• Page End: 1217
• Publication Date: 2020-02-07
• Subjects: Aortic annulus -- Aortic valve repair -- Dacron ring annuloplasty -- Double-ring annuloplasty -- Dynamic characterization -- Aortic insufficiency; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa001
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Aortic valve repair procedures for the treatment of isolated aortic valve insufficiency may be improved by stabilizing the functional aortic annulus using a double annuloplasty ring at the aortic annulus and sinotubular junction (STJ). The objective of this study was to compare the geometrical changes and aortic root stress distribution when using a single subvalvular ring and a double sub- and supravalvular ring in vivo . METHODS: Both the single- and double-ring procedures were performed successively in nine 80-kg pigs. Measurements were performed intraoperatively using sonomicrometry crystals in the aortic root to evaluate geometrical changes and annular and STJ force transducers measuring the segmental radial stress distribution. RESULTS: The total force in the STJ was significantly reduced after the double-ring procedure from 1.7 ± 0.6 to 0.04 ± 1.1 N ( P = 0.001). The double-ring procedure significantly reduced the STJ area from 234.8 ± 37.6 to 147.5 ± 31.8 mm 2 ( P = 0.001) and expansibility from 17 ± 6% to 8 ± 3% ( P = 0.001). With the single-ring procedure, the STJ shape was circular but became more oval with the double-ring procedure. The double-ring procedure did not affect stress distribution or geometry in the aortic annulus. CONCLUSIONS: The double-ring procedure stabilized the whole aortic root by reducing radial stress distribution in the STJ more efficiently than the single-ring procedure. Both area and expansibility were reduced with the double-ring procedure. These results confirm the importance of addressing the entire functional aortic annulus for optimal aortic valve repair procedures.