Key result
Aortic wall trimming reduced mean transvalvular gradient in cryo-preserved and fresh grafts (e.g., 7.6 to 5.2 mmHg) but increased it in glutaraldehyde-preserved valves (7.1 to 9.2 mmHg).
Why the study?
Does aortic wall trimming alter the mean transvalvular gradient of different types of stentless aortic valves in an in-vitro model?
Does aortic wall trimming alter the mean transvalvular gradient of different types of stentless aortic valves in an in-vitro model?
In-vitro testing shows that aortic wall trimming improves hemodynamics in fresh and cryo-preserved grafts but impairs glutaraldehyde-preserved stentless valves, suggesting the latter should be implanted as a full root.
Trimming may lower gradients in fresh/cryopreserved grafts but raise them in glutaraldehyde-preserved valves; leaves open optimal implantation technique pending clinical data.
Various techniques of stentless aortic valve implantation with or without wall components exist. We investigated the in-vitro performance of stentless valves without or with aortic wall removal mimicking root versus subcoronary implantation. Glutaraldehyde-preserved stentless aortic valves (gpSVG), cryo-preserved human homografts (cpHG), cryo-preserved xenografts (cpXG), and fresh xenografts (fXG) were used. Valves were mounted as full roots or trimmed in a mock circuit. Mean transvalvular gradient (MTVG, mmHg) was measured. Distensibility was quantified using post-systolic backflow volume (BV, ml) - after valve closure. Function was visualized by means of a high-speed camera. Glutaraldehyde-preserved valves exhibited higher MTVG than cryo-preserved or fresh substitutes. After trimming, cpHG, cpXG, and fXG demonstrated marked reduction of MTVG (cpHG: 7.6-5.2 mmHg; cpXG: 6.7-4.9 mmHg; fXG: 8.4-5.2 mmHg). In contrast, after trimming gpSVG exhibited a significant increase of MTVG (7.1-9.2 mmHg). BV remained constant. Visualization indicated maintained distension of all valves and types of all sizes after trimming. In fresh and cryo-preserved grafts, aortic wall trimming resulted in significantly improved systolic performance while glutaraldehyde-preserved stentless valves demonstrated systolic impairment after wall resection. Subcoronary implantation of fresh or cryo-preserved aortic valves may therefore be preferred. In contrast, glutaraldehyde-preserved valves are dependent on wall suspension and may therefore be implanted as a root.
No takes yet. Share an insight, caveat, or question.
Kuehnel et al. (2006) studied In-vitro stentless aortic valve performance. Aortic wall trimming vs. Full root mounting was evaluated on Mean transvalvular gradient (MTVG). Aortic wall trimming reduced mean transvalvular gradient in cryo-preserved and fresh grafts (e.g., 7.6 to 5.2 mmHg) but increased it in glutaraldehyde-preserved valves (7.1 to 9.2 mmHg).
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: