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In vitro comparison of three techniques for ventriculo-aortic junction annuloplasty.
MedLine Citation:
PMID:  22228850     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVESIn aortic valve repair, reduction and stabilization of the ventriculo-aortic junction (VAJ) is generally recommended. In this in vitro study, we compare three techniques of annuloplasty: the subcommissural annuloplasty (SCA), the internal ring (IR) and the external ring (ER) annuloplasty.METHODSTen fresh porcine aortic valve preparations were tested in a pulsatile mock loop. Each sample was tested untreated (baseline: B). The annuloplasty techniques were then performed successively in each sample. Each technique was tested, then removed and the following technique performed. SCA was applied at 50% of interleaflet triangle height; the ER and IR were applied with a moderate reduction (15-20%) of the VAJ. Hydrodynamic, video and echographic parameters were collected. Flow rate and arterial pressure were maintained consistently between groups.RESULTSEffective orifice area decreased significantly with each annuloplasty technique compared with baseline (P < 0.001). Mean transvalvular pressure drop was significantly higher in the ER and IR vs SCA (P = 0.007). Annuloplasty reduced valve opening and closing time in comparison to baseline. Echocardiography confirmed that the VAJ experienced a greater reduction with the ER and IR vs SCA. A narrowing of the lower third of the sinuses of Valsalva was observed after the ER, and subvalvular narrowing was observed after the IR. Valve coaptation increased with all annuloplasty techniques.CONCLUSIONSThe three annuloplasty techniques examined demonstrated differential effects on aortic valve function and root morphology. The ER and IR have greater potential to reduce VAJ diameter in comparison to SCA. The IR induced a subvalvular remodelling of the VAJ, whereas the ER induced a paravalvular remodelling.
Authors:
Laurent de Kerchove; Riccardo Vismara; Andrea Mangini; Gianfranco Beniamino Fiore; Joel Price; Philippe Noirhomme; Carlo Antona; Gebrine El Khoury
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-6
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiothoracic and Vascular Surgery, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
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