Key result
Aortic valve neocuspidalization is linked to ~0.5-Pa lower aortic wall shear stress vs. biological AVR.
Why the study?
Increased wall shear stress is linked to histological alterations of the aortic wall, but wall shear stress after aortic valve neocuspidalization compared with biological prostheses had not been established.
Does aortic valve neocuspidalization reduce wall shear stress on the ascending aorta compared to biological aortic valve replacement?
Cohort (n=20)
nonrandomized
No
Does aortic valve neocuspidalization reduce wall shear stress on the ascending aorta compared to biological aortic valve replacement?
Aortic valve neocuspidalization using the Ozaki technique yields more physiological ascending aortic hemodynamics with lower wall shear stress than standard bioprosthetic valves, potentially reducing long-term risk of aortic dilatation.
Neocuspidalization was associated with lower aortic wall shear stress; hypothesis-generating for dilatation risk and requires randomized confirmation.
OBJECTIVES: Aortic valve neocuspidalization aims to replace the 3 aortic cusps with autologous pericardium pre-treated with glutaraldehyde, and it is a surgical alternative to the classical aortic valve replacement (AVR). Image-based patient-specific computational fluid dynamics allows the derivation of shear stress on the aortic wall [wall shear stress (WSS)]. Previous studies support a potential link between increased WSS and histological alterations of the aortic wall. The aim of this study is to compare the WSS of the ascending aorta in patients undergoing aortic valve neocuspidalization versus AVR with biological prostheses. METHODS: This is a prospective nonrandomized clinical trial. Each patient underwent a 4D-flow cardiac magnetic resonance scan after surgery, which informed patient-specific computational fluid dynamics models to evaluate WSS at the ascending aortic wall. The adjusted variables were calculated by summing the residuals obtained from a multivariate linear model (with ejection fraction and left ventricle outflow tract-aorta angle as covariates) to the mean of the variables. RESULTS: Ten patients treated with aortic valve neocuspidalization were enrolled and compared with 10 AVR patients. The aortic valve neocuspidalization group showed a significantly lower WSS in the outer curvature segments of the proximal and distal ascending aorta as compared to AVR patients (P = 0.0179 and 0.0412, respectively). WSS levels remained significantly lower along the outer curvature of the proximal aorta in the aortic valve neocuspidalization population, even after adjusting the WSS for the ejection fraction and the left ventricle outflow tract-aorta angle [2.44 Pa (2.17-3.01) vs 1.94 Pa (1.72-2.01), P = 0.02]. CONCLUSIONS: Aortic valve neocuspidalization hemodynamical features are potentially associated with a lower WSS in the ascending aorta as compared to commercially available bioprosthetic valves.
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Pirola et al. (2023) conducted a cohort in Aortic valve disease (n=20). Aortic valve neocuspidalization (Ozaki technique) vs. Aortic valve replacement with biological prostheses was evaluated on Adjusted wall shear stress (WSS) along the outer curvature of the proximal ascending aorta (p=0.02). Aortic valve neocuspidalization significantly lowered adjusted wall shear stress along the outer curvature of the proximal ascending aorta compared to biological aortic valve replacement (1.94 Pa vs 2.44 Pa, P=0.02).
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