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You are here: Contents > 2006 > Volume 15 Number 3 May 2006 > AORTIC VALVE DISEASE > In-Vitro Comparison of Aortic Valve Hemodynamics between Aortic Root Remodeling and Aortic Valve Reimplantation

In-Vitro Comparison of Aortic Valve Hemodynamics between Aortic Root Remodeling and Aortic Valve Reimplantation

Thomas P. Graeter1, Roland Fries2, Diana Aicher1, (Late) Helmut Reul3, Christoph Schmitz3, 

Hans-Joachim Schafers1
Departments of 1Thoracic and Cardiovascular Surgery and 2Cardiology, University Hospital Homburg, Homburg/Saar, Germany, 3Helmholtz Institute for Biomedical Engineering, University of Technology Aachen, Aachen, Germany

Background and aim of the study: Valve-preserving aortic replacement has become an accepted option for patients with aortic valve regurgitation and aortic dilatation. The relative role of root remodeling versus valve reimplantation inside a vascular graft has been discussed, albeit controversially. In the present study, an in-vitro model was used to investigate the aortic valve hemodynamics of root remodeling and valve reimplantation; roots with supracommissural aortic replacement served as controls.
Methods: Aortic roots with aortoventricular diameter 21 mm were obtained from pigs. Root remodeling was performed using a 22-mm graft (group I, n = 6), or valve reimplantation with a 24-mm graft (group II, n = 7). Control roots were treated by supracommissural aortic replacement (22-mm graft; group III, n = 7). Using an electrohydraulic, computer-controlled pulse duplicator, the valves were tested at flows of 2, 4, 5, 7, and 9 l/min at a heart rate of 70 /min and a mean arterial pressure of 100 mmHg. Parameters assessed included: mean pressure gradient,


effective orifice area, valve closure and regurgitant volume, and energy loss due to ejection, valve closure and regurgitation. Data were compared using ANOVA.
Results: There were no differences between the three groups in terms of regurgitant volume, energy loss due to valve regurgitation, or valve closure. The aortic valve orifice area was largest and systolic gradient lowest in group I at all flow rates (p <0.001). Ejection energy loss was lowest in group I at all flow rates (9 l/min: group I, 128 ± 21 mJ; group II, 399 ± 46 mJ; group III, 312 ± 27 mJ; p <0.001). Valve closure volumes were similar in groups I and III, but significantly lower in group II at all flow rates (p = 0.047).
Conclusion: In this standardized experimental setting, root remodeling - but not valve reimplantation - resulted in physiologic hemodynamic performance of the aortic valve with regard to orifice area, pressure gradient, and systolic energy loss.
The Journal of Heart Valve Disease 2006;15:329-335

In-Vitro Comparison of Aortic Valve Hemodynamics between Aortic Root Remodeling and Aortic Valve Reimplantation

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