Impact of graft size and resuspension level of the commissures on aortic insufficiency after reimplantation of the aortic valve.
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.


METHODS
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.


CONCLUSIONS
Resuspension of the commissures within the graft has a more important impact on early failure rates than the choice of graft size.
Babin-Ebell
J
J
Department of Cardiac Surgery, University Hospitals of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. joerg.babin-ebell@web.de
De Vivo
F
F
Vogt
P R
PR
Roth
P
P
D000818:Animals; D001021:Aortic Valve / Q000637:transplantation*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001705:Bioprosthesis; D004195:Disease Models, Animal; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D012092:Replantation / Q000379:methods*; D013536:Suture Techniques; D013552:Swine; D014184:Transplantation, Homologous; D016896:Treatment Outcome