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You are here: Contents > 2018-19 > Volume 27 Number 4 (2018-19) > AORTIC VALVE DISEASE > Aortic Valve Repair Techniques Affect the Annulus Differently: An In Vitro Characterization

Aortic Valve Repair Techniques Affect the Annulus Differently: An In Vitro Characterization

Troels Lading1,2,4, Thomas Lindskow1,2, Mona Sharghbin1,2, Leila Louise Benhassen1,2, Tommy Bechsgaard2,3, Diana M. Ropcke1,2, Sten Lyager Nielsen1,2, Peter Johansen3

1Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
2Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
3Dept. of Engineering, Aarhus University, Aarhus Denmark
4Electronic correspondence: troels.lading@gmail.com

Background and aim of the study: Since the early 1990s, when reimplantation and remodeling techniques were introduced as aortic valve-sparing procedures, reimplantation has proven to provide a better stabilization of the aortic annulus. An annuloplasty ring as an adjunct procedure to the remodeling procedure has been suggested for annular stabilization similar to the reimplantation procedure. The study aim was to evaluate and compare, in vitro, the biomechanical annular alterations of the reimplantation and remodeling techniques, both with and without an annuloplasty ring.

Methods: Thirty porcine aortic roots were randomized to either no repair (n = 6), no repair with an annular ring (n = 6), remodeling (n = 6), remodeling with an annular ring (n = 6), or reimplantation (n = 6). A pulsatile in vitro set-up was used. For measurements of force distribution, a dedicated strain gauge-based force transducer was developed capable of measuring inward and outward distension of the aortic annulus. Annular distensibility was evaluated with two-dimensional echography. A force-distensibility ratio was determined to define the force per geometric change.


Results: Radial outward cyclic forces from diastole to systole after reimplantation (0.2 ± 0.1 N), remodeling with annuloplasty ring (0.2 ± 0.1 N), and native aortic root with an annuloplasty ring (0.2 ± 0.02 N), were significantly decreased compared to native (0.6 ± 0.2 N) and remodeling without annuloplasty ring (0.5 ± 0.2 N) (p <0.02). The force-distensibility ratio of the native aortic root with ring, remodeling with ring, and reimplantation was significantly lower compared to native root without ring (p <0.01).

Conclusion: The results of this in vitro study indicated that an annuloplasty ring, when used as an adjunct device with the remodeling technique, provides similar annular stabilization as does the reimplantation procedure, and suggests that this may be the answer to the lacking stabilization after remodeling alone. However, the long-term stability of the two procedures is still to be addressed in clinical follow up studies.

Presented in part as an oral presentation at the Annual Meeting of the Heart Valve Society, 2nd-4th March 2017, Monaco

The Journal of Heart Valve Disease 2018-19;27:251-258

Aortic Valve Repair Techniques Affect the Annulus Differently: An In Vitro Characterization

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