The role of the sinuses of Valsalva in aortic root flow dynamics and aortic root surgery: evaluation by magnetic resonance imaging.
OBJECTIVE
Combined replacement of the aortic valve and ascending aorta using a composite graft represents the standard treatment for dilated aortic root with concomitant structural damage of the aortic valve, especially when the aortic valve cannot be preserved. Unfortunately, hemodynamic changes associated with prosthetic replacement of the aortic root have not been fully elucidated. The study aim was to compare hemodynamics within the replaced aortic root using either a prosthetic vascular graft with bulges mimicking the sinuses of Valsalva and including a stented pericardial valve, or a straight xenopericardial conduit and a stentless porcine valve.


METHODS
Between July 2004 and March 2006, a total of 35 patients (mean age 65.2 years: range: 32-80 years) was enrolled into the present study. Aortic root replacement was performed in nine patients with a Valsalva graft (Gelweave Valsalva; Vascutek, Renfrewshire, UK) including a stented pericardial valve, and in 19 patients with a xenopericardial conduit containing a stentless porcine valve. All patients underwent postoperative magnetic resonance imaging (MRI). A control group of seven patients allowed for comparison with native aortic root hemodynamics.


RESULTS
Maximum flow-velocity above the aortic valve as one marker of compliance of the aortic root was slightly higher in patients with a Valsalva graft compared to native aortic roots (1.9 m/s versus 1.3 m/s, p = 0.001), but was significantly lower than in patients with the xenopericardial graft without neo-sinuses (1.3 m/s versus 2.4 m/s, p < 0.001).


CONCLUSIONS
The pre-shaped bulges in the prosthetic Valsalva graft effectively mimic the native sinuses of Valsalva, improve compliance of the aortic root, and result in a more physiologic flow pattern, as demonstrated by postoperative MRI.
Department of Cardiovascular Surgery, University of Berne, Switzerland. florian.schoenhoff@gmail.com
Florian S
FS
Schoenhoff
Christos
C
Loupatatzis
Franz F
FF
Immer
Christoforos
C
Stoupis
Thierry P
TP
Carrel
Friedrich S
FS
Eckstein
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology* / Q000601:surgery*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012850:Sinus of Valsalva / Q000503:physiopathology*; D013536:Suture Techniques