title: Aortic root performance after valve sparing procedure: a comparative finite element analysis.
abstract: David and Yacoub sparing techniques are the most common procedures adopted for the surgical correction of aortic root aneurysms. These surgical procedures entail the replacement of the sinuses of Valsalva with a synthetic graft, inside which the cusps are re-suspended. Root replacement by a synthetic graft may result in altered valve behaviour both in terms of coaptation and stress distribution, thus leading to the failure of the correction. A finite element approach was used to investigate this phenomenon; four 3D models of the aortic root were developed to simulate the root in physiological, pathological and post-operative conditions after the two different surgical procedures. The physiological 3D geometrical model was developed on the basis of anatomical data obtained from echocardiographic images; it was then modified to obtain the pathological and post-operative models. The effectiveness of both techniques was assessed by comparison with the first two simulated conditions, in terms of stresses acting on the root, leaflet coaptation and interaction between leaflets and the graft during valve opening. Results show that both sparing techniques are able to restore aortic valve coaptation and to reduce stresses induced by the initial root dilation. Nonetheless, both techniques lead to altered leaflet kinematics, with more evident alterations after David repair.
authors.affiliation: Bioengineering Department, Politecnico di Milano, Milan, Italy. monica.soncini@polimi.it
authors.forename: Monica
authors.initials: M
authors.lastname: Soncini
authors.forename: Emiliano
authors.initials: E
authors.lastname: Votta
authors.forename: Silvia
authors.initials: S
authors.lastname: Zinicchino
authors.forename: Valeria
authors.initials: V
authors.lastname: Burrone
authors.forename: Andrea
authors.initials: A
authors.lastname: Mangini
authors.forename: Massimo
authors.initials: M
authors.lastname: Lemma
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
authors.forename: Alberto
authors.initials: A
authors.lastname: Redaelli
mesh_terms: D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D020342:Finite Element Analysis; D006350:Heart Valve Prosthesis; D006801:Humans; D008955:Models, Cardiovascular; D012850:Sinus of Valsalva / Q000601:surgery*