Key result
Reducing commissure height in porcine valves increases reflux and early failure more than reducing graft size.
Why the study?
Does the reduction of commissure fixation level or graft size increase valve insufficiency in reimplanted porcine aortic valves?
Does the reduction of commissure fixation level or graft size increase valve insufficiency in reimplanted porcine aortic valves?
In an in vitro porcine model of valve-sparing aortic root replacement, proper resuspension height of the commissures is more critical for preventing early valve insufficiency than the choice of graft size.
Answers are grounded in this paper and cite their sources.
Commissural height may warrant priority over graft sizing in valve-sparing root replacement; hypothesis-generating in porcine model, requires human validation.
BACKGROUND: In addition to the size of the graft, the resuspension of the commissures has been described as important for valve function in valve-sparing aortic root replacement procedures. This study describes the influence of a stepwise reduction of the fixation level of the commissures within the graft as well as a stepwise reduction of graft size on valve insufficiency. METHOD: Porcine aortic valves were reimplanted into a tubular graft and the height of the commissures was reduced in a stepwise manner. In a second series of experiments, the diameter of the grafts was reduced by 30 % and 50 %. RESULTS: A reduction of the commissure heights by 10 % and 20 % caused a significant increase in reflux water. Using the criteria of homograft preparation, a 10 %, but not a 20 %, reduction was tolerated. The coaptation level of the valve became increasingly lower, indicating a higher risk for late valve incompetence. A reduction of the prosthesis diameter by 30 % and 50 % did not result in insufficiency of the valve but it lowered the coaptation level. CONCLUSION: Resuspension of the commissures within the graft has a more important impact on early failure rates than the choice of graft size.
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Babin–Ebell et al. (2007) studied Aortic Insufficiency. Reduction of commissure fixation level and graft size was evaluated on Reflux water and coaptation level. Reducing commissure heights by 10% and 20% in reimplanted porcine aortic valves caused a significant increase in reflux water, having a greater impact on early failure than reducing graft size.
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