Aortic root reconstruction: from principles to numerical modeling.
Reconstructing the aortic root represents a formidable task for modern cardiac surgery. By the time an individual reaches 75 years of age his or her aortic apparatus has been submitted to more than three billion cardiac cycles, leaving no place for engineering flaws or misconception. The rules that have been established through millions of years of evolution are strict and demanding. During the past two decades, the cardiovascular community has manifested a growing interest in this topic, especially in patients with medial degenerative disease. However, the ideal reconstruction is still to be devised. To achieve a physiological root reconstruction that preserves the diastolic and systolic function of the valve as well as prevents premature degeneration, a few principles have to be respected. Neglecting any one of them has consequences on the normal functioning of the aortic valve. Current surgical techniques have limitations due to the limited availability of biomaterial and the lack of useful tools to assess pathophysiological conditions and assist surgeons in designing better custom-made reconstructions of the aortic root. The authors present a review of the principles behind the physiology of the reconstruction of the aortic root, and review the literature on computerized models exploring the biomechanics and kinetics of the ascending aorta.
Cartier
Raymond
R
Biomechanics Group of the Montreal Heart Institute, Department of Cardiac Surgery, Quebec. rc2910@aol.com
Ranga
Adrian
A
Mongrain
Rosaire
R
D001011:Aorta / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000503:physiopathology / Q000601:surgery; D001021:Aortic Valve / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods