An external aortic root device for decreasing aortic regurgitation: in vitro and in vivo animal studies.
OBJECTIVE
The purpose of this study was to determine if a device placed externally around the aortic root decreases regurgitant flow in acute aortic regurgitation.


BACKGROUND
Aortic regurgitant flow is dependent on central aortic pressure and the aortic root and leaflet geometry. It may be possible to decrease aortic regurgitant severity by reducing aortic root size or dimension changes.


METHODS
Aortic regurgitation was created in eight calf heart specimens suspended in a continuous flow system. Retrograde and antegrade aortic flow and distending aortic pressure were measured at baseline and after placement of an external aortic device at the level of the aortic annulus. In two additional specimens, the incompetent aortic valve was visualized fiberoptically before and after placement of the external device. Acute aortic regurgitation was created surgically in four live calves by excising a portion of the aortic leaflets. Antegrade and retrograde flow, left ventricular pressure, and central aortic pressure were measured at baseline, after creation of aortic regurgitation, and after placement of the external device.


RESULTS
In the in vitro calf specimens, regurgitant flow decreased from 46.9 cc/sec to 15.1 cc/sec (66.0% +/- 21.8% decrease) after placement of the external device (p < 0.001). The regurgitant orifice area decreased from 0.13 +/- 0.04 cm2 to 0.04 +/- 0.02 cm2 after device placement (p < 0.001). Antegrade flow was reduced to a smaller extent (20.0% +/- 19.2% decrease) by the device (p < 0.05). Placement of the device around the aorta resulted in improved coaptation of the leaflets with a marked reduction in defect size by endoscopic visualization. Use of the external aortic device was associated with improvement in aortic regurgitant severity in three of four calves with surgically created aortic regurgitation.


CONCLUSIONS
In these preliminary studies, acute experimental aortic regurgitant severity is decreased by the use of an external aortic device, probably due to reduction in aortic annular dimension changes and improved aortic leaflet apposition. Further studies are needed to determine the effectiveness of this device in chronic aortic regurgitation.
Reimold
S C
SC
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Aranki
S F
SF
Caguioa
E S
ES
Solomon
S D
SD
Birjiniuk
V
V
Cohn
L H
LH
Lee
R T
RT
D000818:Animals; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002417:Cattle; D015150:Echocardiography, Doppler; D004867:Equipment Design; D011108:Polymers; D019736:Prostheses and Implants; D012039:Regional Blood Flow / Q000502:physiology; D013193:Stainless Steel; D013318:Stroke Volume / Q000502:physiology; D013499:Surface Properties; D017725:Ventricular Pressure / Q000502:physiology
D011108:Polymers; D013193:Stainless Steel; C017902:lexan