Why the study?
To determine any increased stresses in pulmonary autograft root and leaflet compared to native aorta components to understand late durability and regions prone to dilatation.
Finite element analysis demonstrates that mechanical deformation and potential failure of pulmonary autografts in the Ross operation increase with conduit length, highlighting the importance of implant technique.
May guide shorter autograft segments in Ross procedures to reduce deformation risk; leaves open human validation.
Ross operation might be a valid option for congenital and acquired left ventricular outflow tract disease in selected cases. As the pulmonary autograft is a living substitute for the aortic root that bioinspired the Ross operation, we have created an experimental animal model in which the vital capacity of the pulmonary autograft (PA) has been studied during physiological growth. The present study aims to determine any increased stresses in PA root and leaflet compared to the similar components of the native aorta. An animal model and a mathematical analysis using finite element analysis have been used for the purpose of this manuscript. The results of this study advance our understanding of the relative benefits of pulmonary autograft for the management of severe aortic valve disease. However, it launches a warning about the importance of the choice of the length of the conduits as mechanical deformation, and, therefore, potential failure, increases with the length of the segment subjected to stress. Understanding PA root and leaflet stresses is the first step toward understanding PA durability and the regions prone to dilatation, ultimately to refine the best implant technique.
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Nappi et al. (2020) studied this question.
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