title: Impact of graft size and resuspension level of the commissures on aortic insufficiency after reimplantation of the aortic valve.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, University Hospitals of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. joerg.babin-ebell@web.de
authors.forename: J
authors.initials: J
authors.lastname: Babin-Ebell
authors.forename: F
authors.initials: F
authors.lastname: De Vivo
authors.forename: P R
authors.initials: PR
authors.lastname: Vogt
authors.forename: P
authors.initials: P
authors.lastname: Roth
mesh_terms: 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