Key result
The double-ring procedure significantly reduced total force in the sinotubular junction compared to the single-ring procedure (0.04 vs 1.7 N, P=0.001) in an in vivo pig model.
Why the study?
Aortic valve repair for isolated aortic valve insufficiency may be improved by stabilizing the functional aortic annulus with a double ring, but geometrical and stress distribution differences compared to a single ring required in vivo evaluation.
Does a double annuloplasty ring reduce aortic root stress and improve geometry compared to a single ring in a porcine model?
Does a double annuloplasty ring reduce aortic root stress and improve geometry compared to a single ring in a porcine model?
Absolute Event Rate: 0.04% vs 1.7%
p-value: p=0.001
A double annuloplasty ring stabilizes the aortic root by reducing radial stress in the STJ more efficiently than a single ring in a porcine model.
OBJECTIVES: Aortic valve repair procedures for the treatment of isolated aortic valve insufficiency may be improved by stabilizing the functional aortic annulus using a double annuloplasty ring at the aortic annulus and sinotubular junction (STJ). The objective of this study was to compare the geometrical changes and aortic root stress distribution when using a single subvalvular ring and a double sub- and supravalvular ring in vivo. METHODS: Both the single- and double-ring procedures were performed successively in nine 80-kg pigs. Measurements were performed intraoperatively using sonomicrometry crystals in the aortic root to evaluate geometrical changes and annular and STJ force transducers measuring the segmental radial stress distribution. RESULTS: The total force in the STJ was significantly reduced after the double-ring procedure from 1.7 ± 0.6 to 0.04 ± 1.1 N (P = 0.001). The double-ring procedure significantly reduced the STJ area from 234.8 ± 37.6 to 147.5 ± 31.8 mm2 (P = 0.001) and expansibility from 17 ± 6% to 8 ± 3% (P = 0.001). With the single-ring procedure, the STJ shape was circular but became more oval with the double-ring procedure. The double-ring procedure did not affect stress distribution or geometry in the aortic annulus. CONCLUSIONS: The double-ring procedure stabilized the whole aortic root by reducing radial stress distribution in the STJ more efficiently than the single-ring procedure. Both area and expansibility were reduced with the double-ring procedure. These results confirm the importance of addressing the entire functional aortic annulus for optimal aortic valve repair procedures.
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Benhassen et al. (2020) studied Isolated aortic valve insufficiency (n=9). Double annuloplasty ring vs. Single subvalvular ring was evaluated on Total force in the sinotubular junction (N) (p=0.001). The double-ring procedure significantly reduced total force in the sinotubular junction compared to the single-ring procedure (0.04 vs 1.7 N, P=0.001) in an in vivo pig model.
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