title: Apicoaortic conduit and cerebral perfusion in mixed aortic valve disease: a computational analysis.
abstract: OBJECTIVE
  The revival of the apicoaortic conduit has attracted new interest in this alternative treatment for severe aortic stenosis unsuitable for conventional valve replacement. However, doubts still exist about the perfusion of the epiaortic vessels after apicoaortic conduit implantation, especially when severe aortic stenosis is associated with aortic valve insufficiency. The aim of the study was to evaluate the perfusion of the epiaortic vessels (innominate artery, left carotid artery and left subclavian artery) in cases of mixed aortic valve disease before and after apicoaortic conduit implantation.
  
  
  METHODS
  Starting from the data of a real patient with severe aortic stenosis and mild aortic insufficiency who underwent apicoaortic conduit implantation, we created a computational model where severe aortic valve stenosis was associated with different grades of aortic insufficiency (mild, medium and moderate).
  
  
  RESULTS
  A total of six combinations were analysed. In all simulations, the more severe the concomitant aortic insufficiency, the more the flow through the epiaortic vessels was diminished. After apicoaortic conduit implantation, there was an absolute augmentation of the median output in each epiaortic vessel compared with the same combination of mixed aortic valve disease before implantation. Interestingly, retrograde flow from the conduit in the descending aorta was minimal and did not contribute to the improved output of the epiaortic vessels.
  
  
  CONCLUSIONS
  The computational analysis suggested a protective effect, rather than steal phenomenon, of the apicoaortic conduit towards the cerebral perfusion, even in cases of mixed aortic valve disease.
authors: Bioengineering Unit, Magna Graecia University, Catanzaro, Italy.
authors: Gionata
authors: G
authors: Fragomeni
authors: Michele
authors: M
authors: Rossi
authors: Francesca
authors: F
authors: Condemi
authors: Rosario
authors: R
authors: Mazzitelli
authors: Giuseppe Filiberto
authors: GF
authors: Serraino
authors: Attilio
authors: A
authors: Renzulli
mesh_terms: D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000503:physiopathology*; D006348:Cardiac Surgical Procedures; D002339:Carotid Arteries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D003198:Computer Simulation; D006801:Humans; D008955:Models, Cardiovascular; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D013348:Subclavian Artery / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aorta/aortic; Cerebral circulation; Circulatory haemodynamics; Computer applications; Heart valve
references: Radiographics. 2000 Sep-Oct;20(5):1279-99; discussion 1299-301
references: 10992018
references: Ann Thorac Surg. 2009 Mar;87(3):927-8
references: 19231422
references: J Thorac Cardiovasc Surg. 2009 Mar;137(3):680-7
references: 19258088
references: Ann Surg. 1910 Jul;52(1):83-95
references: 17862563
references: Surgery. 1976 Dec;80(6):674-80
references: 137539
references: J Thorac Cardiovasc Surg. 2006 Jul;132(1):155-6
references: 16798319
references: AJNR Am J Neuroradiol. 2003 Apr;24(4):559-66
references: 12695182
references: Ann Thorac Surg. 2012 Jan;93(1):290-3
references: 22186447
references: Tex Heart Inst J. 2000;27(1):24-8
references: 10830624
references: Tex Heart Inst J. 2005;32(3):294-8
references: 16392208
references: Circulation. 1955 Apr;11(4):564-75
references: 14364731
references: Ann Thorac Surg. 2010 Jul;90(1):136-43
references: 20609764
references: Circulation. 2008 Sep 30;118(14):1460-6
references: 18794389
references: Ann Thorac Surg. 2011 Oct;92(4):1332-7; discussion 1337-8
references: 21958780
references: Asian Cardiovasc Thorac Ann. 2006 Aug;14(4):e76-9
references: 16868094
references: Comput Math Methods Med. 2012;2012:156094
references: 22654957
references: N Engl J Med. 2012 Nov 15;367(20):1954-6
references: 23150964
references: Ann Biomed Eng. 2002 Apr;30(4):483-97
references: 12086000
references: Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):486-8
references: 20007638
references: Circulation. 1981 Aug;64(2):375-80
references: 7249305
references: Eur Heart J. 2010 Dec;31(23):2959
references: 20685678
references: J Thorac Cardiovasc Surg. 2006 Oct;132(4):796-801
references: 17000290