Key result
The presence of pseudosinuses of Valsalva in a Bentall conduit did not significantly influence coronary flow reserve compared to standard conduits or natural sinuses (3.1 vs 3.6 vs 3.7, P=0.2).
Why the study?
Does a conduit with pseudosinuses of Valsalva alter coronary flow characteristics compared to a standard cylindrical conduit in patients undergoing a Bentall procedure?
Observational (n=21)
Does a conduit with pseudosinuses of Valsalva alter coronary flow characteristics compared to a standard cylindrical conduit in patients undergoing a Bentall procedure?
Absolute Event Rate: 3.1% vs 3.6%
p-value: p=0.2
The use of a conduit with pseudosinuses of Valsalva during a Bentall procedure does not significantly change coronary flow reserve compared to a standard cylindrical conduit, although it may alter the systolic/diastolic flow pattern.
Similar CFR with pseudosinus versus standard Bentall conduits; leaves open effects on flow patterns or outcomes.
OBJECTIVES: The sinuses of Valsalva are known to contribute to the normal function of the aortic valve. Little is known about their role in promoting coronary artery blood flow. The aim of this study was to compare coronary artery flow characteristics among patients undergoing a Bentall operation by means of a conventional cylindrical Dacron conduit or with a new conduit with pseudosinuses of Valsalva or in patients retaining their natural sinuses of Valsalva after aortic valve and supracoronary ascending aorta replacement. METHODS: One year after a Bentall procedure with a standard cylindrical Dacron conduit (7 patients, group A) or with the new conduit (7 patients, group B), or after aortic valve and ascending aortic replacement (control group, 7 patients, group C) coronary flow velocity reserve and diastolic to systolic time integral ratio at baseline and after maximal hyperemia (with 40 microg of adenosine) were assessed by using a 0.014-in. Doppler guidewire positioned in the middle portion of the left anterior descending coronary artery. All patients were in NYHA class I, sinus rhythm and free of coronary disease. RESULTS: Arterial blood pressures and heart rate were comparable among groups. Intracoronary Doppler measurements did not show any significant difference in coronary vascular reserve between the three groups (3.6+/-0.4 vs 3.1+/-0.7 vs 3.7+/-0.5, P = 0.2). A greater diastolic component at baseline was present in group B patients (5.5+/-1.9 vs 3.5+/-0.9 in group A and 3.7+/-0.9 in group C, P = 0.024). After maximal hyperemia the diastolic component increased slightly in group A patients (8%) while both in groups B and C significantly decreased (-15 and -20%, respectively) (P = 0.017). CONCLUSIONS: The presence of pseudosinuses of Valsalva does not influence coronary flow reserve. After maximal coronary vasodilation the increase in the systolic component of coronary flow is more evident in the presence of sinuses or pseudosinuses of Valsalva, thus suggesting that coronary flow pattern may be affected by the presence of sinuses.
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Tomai et al. (2004) conducted an observational in Aortic valve and ascending aorta replacement (n=21). Bentall procedure with a new conduit with pseudosinuses of Valsalva vs. Standard cylindrical Dacron conduit or natural sinuses of Valsalva was evaluated on Coronary flow velocity reserve (p=0.2). The presence of pseudosinuses of Valsalva in a Bentall conduit did not significantly influence coronary flow reserve compared to standard conduits or natural sinuses (3.1 vs 3.6 vs 3.7, P=0.2).
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