Biomechanics and clinical outcomes of various conduit configurations in valve sparing aortic root replacement

Figures

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  Figure 1. Aortic valve and root mounting system with native coronary arteries attached to the coronary cannulas. (A) The baseline control configuration prior to valve-sparing aortic root replacement repair; (B) the post valve-sparing aortic root replacement configuration using a straight graft.

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  Figure 2. The updated aortic mounting system including the coronary channels through the left ventricular outflow tract mount. Note the coronary channel inflows include cantilevered edges to allow for secure attachment of the native coronary arteries to the coronary channels. The inflow angles were also designed to reflect the natural courses of the coronary arteries in situ.

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  Figure 3. Leaflet motion tracking analysis demonstrating (A) 5 points equally spaced apart including the Arantius nodulus (red) that were identified along the leading edge of each leaflet for tracking. Red: Arantius nodulus of each cusp; Blue: remaining tracking points along the leading edge of each cusp. (B) A set of exemplary displacement plots were generated by converting the spatial-temporal data from the Arantius nodulus of each leaflet. (C) Flutter analyses were completed by performing Fourier transform of the displacement plots shown in (B) to identify main frequency and power. NCC, non-coronary cusp; LCC, left coronary cusp; RCC, right coronary cusp.

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  Figure 4. Exemplary en face views of the same aortic valve in diastole captured by high-speed videography for (A) baseline and after valve-sparing aortic root replacement using the (B) straight graft, (C) Valsalva graft, (D) anticommissural plication, and (E) Stanford modification conduit configurations. Notice the small central regurgitation areas in the samples prepared using the Valsalva graft, anticommissural plication, and Stanford modification conduit configurations.

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  Figure 5. Aortic flow (A), aortic and ventricular pressure (B), left coronary artery flow (C) and right coronary artery flow (D) from baseline and after valve-sparing aortic root replacement repair using SG, VG, ACP, and SMOD. Notice the aortic flow reversal in diastole after repair using the VG, ACP, and SMOD configurations. The aortic flow profiles were overall similar between baseline and repair using the SG configuration. The pressure tracings were also similar among the five different conditions. No left coronary flow difference was observed across the five different conditions. VG and SMOD were associated with decreased right coronary flow compared with baseline. Black—baseline; green—SG; blue—VG; purple—ACP; red—SMOD. Solid lines in (B)—ventricular pressures; dashed lines in (B-D)—aortic pressures. Shaded areas represent standard errors. SG, straight graft; VG, Valsalva graft; ACP, anticommissural plication; SMOD, Stanford modification.

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  Video S1. Leaflet motion tracking demonstrating that 5 points equally spaced apart including the Arantius nodulus along the leading edge of each leaflet were tracked throughout a complete cardiac cycle.

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  Video S2. High-speed videography of an exemplary porcine aortic valve at baseline.

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  Video S3. High-speed videography of an exemplary porcine aortic valve after the valve-sparing aortic root replacement using the straight graft configuration.

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  Video S4. High-speed videography of an exemplary porcine aortic valve after the valve-sparing aortic root replacement using the Valsalva graft configuration.

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  Video S5. High-speed videography of an exemplary porcine aortic valve after the valve-sparing aortic root replacement using the anticommissural plication configuration.

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  Video S6. High-speed videography of an exemplary porcine aortic valve after the valve-sparing aortic root replacement using the Stanford modification configuration.