title: An expansible aortic ring for a physiological approach to conservative aortic valve surgery.
abstract: OBJECTIVE
  Dystrophic aortic insufficiency is characterized by dilation of the aortic annular base and sinotubular junction diameters preventing coaptation of thin and pliable cusps amenable to valve repair. An expansible aortic ring was designed to reduce dilated aortic root diameters to increase valvular coaptation height while maintaining root dynamics. The properties of the device were tested in vitro and in vivo in an ovine model.
  
  
  METHODS
  Expansible rings were composed of an elastomer core covered by polyester fabric. After in vitro analysis of their mechanical properties, the rings were implanted in 6 sheep at both the level of the annular base and sinotubular junction (double subvalvular and supravalvular external aortic annuloplasty). Root dynamics were assessed by using intracardiac ultrasonography before surgical intervention and at 6 months. Histologic, scanning electron microscopic, and mechanical studies were then performed on explanted samples.
  
  
  RESULTS
  The expansible ring produced a significant reduction of the aortic annular base and sinotubular junction diameters. Coaptation height was increased from 2.5 +/- 0.7 mm to 6.2 +/- 1.1 mm (P < .001). Mechanical testing on 6-month explanted samples revealed no significant differences in elastic modulus. Dynamics of the root were well preserved. Histomorphologic studies showed incorporation of the material without degradation.
  
  
  CONCLUSIONS
  Expansible aortic ring implantation produces a significant annuloplasty that increases coaptation height while preserving the dynamics of the aortic root. The effectiveness of the device in treating aortic insufficiency is currently being evaluated in the prospective Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root trial comparing conservative aortic valve surgery versus mechanical valve replacement.
authors.affiliation: INSERM, U 698, Cardiovascular Bioengineering, Bichat University Hospital, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lansac
authors.forename: Isabelle
authors.initials: I
authors.lastname: Di Centa
authors.forename: François
authors.initials: F
authors.lastname: Raoux
authors.forename: Neil
authors.initials: N
authors.lastname: Bulman-Fleming
authors.forename: Adrian
authors.initials: A
authors.lastname: Ranga
authors.forename: Aicha
authors.initials: A
authors.lastname: Abed
authors.forename: Maguette
authors.initials: M
authors.lastname: Ba
authors.forename: Anthony
authors.initials: A
authors.lastname: Paolitto
authors.forename: Didier
authors.initials: D
authors.lastname: Letourneur
authors.forename: Anne
authors.initials: A
authors.lastname: Meddahi-Pellé
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001696:Biomechanical Phenomena; D004108:Dilatation, Pathologic / Q000628:therapy; D004452:Echocardiography; D004867:Equipment Design; D008422:Materials Testing; D019736:Prostheses and Implants; D012756:Sheep; D013314:Stress, Mechanical; D013718:Tensile Strength