Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional-Printed Heart Simulator.

Animals Aorta / surgery Aortic Valve Insufficiency / surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation Humans Models, Cardiovascular Printing, Three-Dimensional Swine
aorta aortic aneurysm aortic root aortic valve biomechanics sinus of valsalva surgery

Journal

Circulation
ISSN: 1524-4539
Titre abrégé: Circulation
Pays: United States
ID NLM: 0147763

Informations de publication

Date de publication:
06 10 2020
Historique:
entrez: 5 10 2020
pubmed: 6 10 2020
medline: 31 8 2021
Statut: ppublish

Résumé

Many graft configurations are clinically used for valve-sparing aortic root replacement, some specifically focused on recapitulating neosinus geometry. However, the specific impact of such neosinuses on valvular and root biomechanics and the potential influence on long-term durability are unknown. Using a custom 3-dimenstional-printed heart simulator with porcine aortic roots (n=5), the anticommissural plication, Stanford modification, straight graft (SG), Uni-Graft, and Valsalva graft configurations were tested in series using an incomplete counterbalanced measures design, with the native root as a control, to mitigate ordering effects. Hemodynamic and videometric data were analyzed using linear models with conduit as the fixed effect of interest and valve as a fixed nuisance effect with post hoc pairwise testing using Tukey's correction. Hemodynamics were clinically similar between grafts and control aortic roots. Regurgitant fraction varied between grafts, with SG and Uni-Graft groups having the lowest regurgitant fractions and anticommissural plication having the highest. Root distensibility was significantly lower in SG versus both control roots and all other grafts aside from the Stanford modification ( In this ex vivo modeling system, clinically used valve-sparing aortic root replacement conduit configurations have comparable hemodynamics but differ in biomechanical performance, with the straight graft most closely recapitulating native aortic root biomechanics.

Sections du résumé

BACKGROUND
Many graft configurations are clinically used for valve-sparing aortic root replacement, some specifically focused on recapitulating neosinus geometry. However, the specific impact of such neosinuses on valvular and root biomechanics and the potential influence on long-term durability are unknown.
METHODS
Using a custom 3-dimenstional-printed heart simulator with porcine aortic roots (n=5), the anticommissural plication, Stanford modification, straight graft (SG), Uni-Graft, and Valsalva graft configurations were tested in series using an incomplete counterbalanced measures design, with the native root as a control, to mitigate ordering effects. Hemodynamic and videometric data were analyzed using linear models with conduit as the fixed effect of interest and valve as a fixed nuisance effect with post hoc pairwise testing using Tukey's correction.
RESULTS
Hemodynamics were clinically similar between grafts and control aortic roots. Regurgitant fraction varied between grafts, with SG and Uni-Graft groups having the lowest regurgitant fractions and anticommissural plication having the highest. Root distensibility was significantly lower in SG versus both control roots and all other grafts aside from the Stanford modification (
CONCLUSIONS
In this ex vivo modeling system, clinically used valve-sparing aortic root replacement conduit configurations have comparable hemodynamics but differ in biomechanical performance, with the straight graft most closely recapitulating native aortic root biomechanics.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.120.046612 PMID: 33017215 PMC: PMC7531510
pubmed: 33017215
doi: 10.1161/CIRCULATIONAHA.120.046612
pmc: PMC7531510
doi:

Types de publication

Comparative Study Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

1361-1373

Subventions

Organisme : NHLBI NIH HHS
ID : R01 HL152155
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL089315
Pays : United States

Références

J Thorac Cardiovasc Surg. 2014 Sep;148(3):872-9; discussion 879-80
pubmed: 24930611
Eur J Cardiothorac Surg. 2017 Feb 1;51(2):316-321
pubmed: 28186283
J Thorac Cardiovasc Surg. 2000 Apr;119(4 Pt 1):753-63
pubmed: 10733765
Circulation. 1999 Nov 23;100(21):2153-60
pubmed: 10571974
Ann Thorac Surg. 1969 Nov;8(5):407-14
pubmed: 5353458
J Thorac Cardiovasc Surg. 2017 Feb;153(2):232-238
pubmed: 27923487
J Thorac Cardiovasc Surg. 2019 Feb;157(2):455-465
pubmed: 30139642
J Thorac Cardiovasc Surg. 2005 Aug;130(2):601-3
pubmed: 16077451
J Thorac Cardiovasc Surg. 2015 Jan;149(1):112-4
pubmed: 25308121
J Thorac Cardiovasc Surg. 2019 Aug;158(2):392-403
pubmed: 30745047
Ann Thorac Surg. 2001 Aug;72(2):487-94
pubmed: 11515887
J Thorac Cardiovasc Surg. 2016 Feb;151(2):330-6
pubmed: 26704057
Med Eng Phys. 2020 Mar;77:10-18
pubmed: 32008935
J Thorac Cardiovasc Surg. 2001 Jul;122(1):39-46
pubmed: 11436035
Eur J Cardiothorac Surg. 2013 Mar;43(3):585-90
pubmed: 22665384
Ann Thorac Surg. 2004 Oct;78(4):1479-81
pubmed: 15464530
Eur J Cardiothorac Surg. 2016 Apr;49(4):1222-7
pubmed: 26362428
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):957-964
pubmed: 29401262
Ann Thorac Surg. 2019 Jul;108(1):90-97
pubmed: 30836099
Nature. 1968 Sep 7;219(5158):1059-61
pubmed: 5673366
J Thorac Cardiovasc Surg. 1993 Mar;105(3):435-8
pubmed: 8445922
Circ Res. 1974 Dec;35(6):871-82
pubmed: 4471354
Clin Anat. 2003 May;16(3):193-6
pubmed: 12673813
Ann Thorac Surg. 1986 Oct;42(4):434-40
pubmed: 3767514
J Thorac Cardiovasc Surg. 2006 Aug;132(2):347-54
pubmed: 16872961
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):1002-1008
pubmed: 29415164
J Thorac Cardiovasc Surg. 1992 Apr;103(4):617-21; discussion 622
pubmed: 1532219
Eur J Cardiothorac Surg. 2018 Jul 1;54(1):48-54
pubmed: 29432524
Interact Cardiovasc Thorac Surg. 2019 Jan 1;28(1):112-119
pubmed: 29961835
J Thorac Cardiovasc Surg. 2020 Feb 19;:
pubmed: 32249088
J Biomech Eng. 2019 Jun 29;:
pubmed: 31253992
J Thorac Cardiovasc Surg. 2004 Jun;127(6):1602-7
pubmed: 15173713
Ann Thorac Surg. 2020 Feb;109(2):505-511
pubmed: 31381871
Ann Thorac Surg. 2010 Mar;89(3):943-6
pubmed: 20172159
J Vis Surg. 2018 May 09;4:95
pubmed: 29963384
Eur J Cardiothorac Surg. 2020 Mar 1;57(3):535-544
pubmed: 31638697
J Card Surg. 2011 Jan;26(1):82-7
pubmed: 21235626
J Thorac Cardiovasc Surg. 2005 Aug;130(2):456-63
pubmed: 16077413
J Thorac Cardiovasc Surg. 2016 Jan;151(1):112-9
pubmed: 26349596
J Thorac Cardiovasc Surg. 2003 Apr;125(4):773-8
pubmed: 12698136
Ann Thorac Surg. 2002 Jul;74(1):53-7
pubmed: 12118803

Auteurs

Michael J Paulsen (MJ)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Annabel M Imbrie-Moore (AM)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.
Department of Mechanical Engineering (A.M.I.M.), Stanford University, CA.

Michael Baiocchi (M)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.
Department of Health Research and Policy (M.B.), Stanford University, CA.

Hanjay Wang (H)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Camille E Hironaka (CE)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Haley J Lucian (HJ)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Justin M Farry (JM)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Akshara D Thakore (AD)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Yuanjia Zhu (Y)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Michael Ma (M)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

John W MacArthur (JW)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.

Y Joseph Woo (YJ)

Department of Cardiothoracic Surgery (M.J.P., A.M.I.-M., M.B., H.W., C.E.H., H.J.L., J.M.F., A.D.T., Y.Z., M.M., J.W.M., Y.J.W.), Stanford University, CA.
Department of Bioengineering (Y.J.W.), Stanford University, CA.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Système cardiovasculaire › Vaisseaux sanguins › Artères › Aorte › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Valvulopathies › Maladie de la valve aortique › Insuffisance aortique › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Équipement et fournitures › Prothèses et implants › Prothèse vasculaire › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Procédures de chirurgie opératoire › Implantation de prothèse › Implantation de prothèses vasculaires › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Techniques d'investigation › Modèles théoriques › Modèles biologiques › Modèles cardiovasculaires › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Sciences de l'information › Affichage de données › Infographie › Conception assistée par ordinateur › Impression tridimensionnelle › Comprehensive Ex Vivo Comparison of 5...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Artiodactyla › Suidae › Comprehensive Ex Vivo Comparison of 5...