Background and aim of the study: Aortic valve resuspension for ascending aortic aneurysm repair is associated with removal of the sinus of Valsalva. This may cause changes in leaflet motion and thus impact on long-term durability. The opening and closing characteristics of the aortic valve leaflets after reimplantation were studied using a published technique and a modification to create a ‘neosinus’, and the results compared to those of an age-matched control group.
Methods: Between September 1995 and March 2002, 25 patients underwent normal aortic root reconstruction (group A), while in a further 21 patients the modified neosinus technique was used (group B). In both groups, the native valve was preserved and suspended inside a tubular prosthesis, with reimplantation of the coronary arteries. Transthoracic and transesophageal studies of aortic valve dynamics were performed intraoperatively, before hospital discharge, and at one year after surgery in all patients; the data were compared with those from a separate group of 25 matched control individuals (group C).
Results: The valve opening velocity was 61.3 ± 20.1, 46.3 ± 8 and 29.2 ± 9.8 cm/s in groups A, B and C, respectively (group A

versus B, p = 0.003; A versus C, p <0.0001; B versus C, p <0.0001). Closing velocity was increased to 57.5 ± 23 and 43.8 ± 7 cm/s in groups A and B, compared to 23.6 ± 7 cm/s in group C (A versus B, p = 0.012; A versus C, p <0.0001; B versus C, p = 0.0002). In seven group A patients, the leaflets touched the prosthetic wall during systole. Slow systolic closing displacement (SCD) amounted to 7.3 ± 6 % of maximal opening in group A and 12.6 ± 5 % in group B (p = 0.05), compared to 21.1 ± 8.3% in group C (group A versus group C, p <0.0001; B versus C, p = 0.002).
Conclusion: Reimplantation of the natural aortic valve in a prosthetic graft causes abnormally high opening and closing speeds, with possibly increased stress. The study results showed lower valve opening and closure dynamics after the creation of a sinus bulge compared to the conventional reimplantation technique. However, mid-term clinical observations showed favorable valve competence for both types of repair. Further long-term follow up is necessary to prove whether more physiological leaflet dynamics lead to improved durability.

The Journal of Heart Valve Disease 2005;14:114-120