(Circulation. 1999;100:2153.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Opening and Closing Characteristics of the Aortic Valve After Different Types of Valve-Preserving Surgery
From the Departments of Cardiac Surgery, Medical University of Lübeck, Lübeck, Germany (R.G.L., C.S., H.-H.S.), and the National Heart and Lung Institute at the Imperial College of Science, Technology, and Medicine, London, UK (M.H.Y.).
Correspondence to Prof H.H. Sievers, Klinik für Herzchirurgie, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. E-mail herzchir{at}medinf.mu-luebeck.de
Background—The surgical approach to aortic root aneurysm and/or dissection remains controversial. The use of valve-sparing operations, which are thought to have many advantages, is increasing. We hypothesized that the particular technique and type of surgery could influence valve motion characteristics and function. Therefore, we studied the instantaneous opening and closing characteristics of the aortic valve after the main 2 types of valve-sparing surgery.
Methods and Results—In 20 patients (10 with tube replacement of the aortic root, group A; and 10 with separate replacement of the sinuses of Valsalva, group B) and 10 controls (group C), transthoracic and transesophageal studies on aortic valve dynamics were performed. Three distinct phases of aortic valve motion were identified. They were as follows: (1) a rapid opening, with a velocity of 20.9±4.2 cm/s in group C, 27.1±10.9 cm/s in group B (P=NS), and 58.3±18.4 cm/s in group A (group A versus group C, P<0.001; group A versus group B, P=0.001); (2) a slow systolic closure, with 12.5±6.6% and 10.8±2.2% of maximal opening in groups C and B, respectively (P=NS), and 3.8±1.6% in group A (group A versus group C, P=0.001; group A versus group B, P<0.001); and (3) a rapid closing movement, with a velocity of 26.3±5.6 cm/s in group C, 32.4±11.4 cm/s in group B (P=NS), and 21.8±3.5 cm/s in group A (group A versus group C, P=NS; group A versus group B, P=0.008). The pressure strain of the elastic modulus was different in groups C and B only at the commissures (682±145 g/cm2 versus 1896±726 g/cm2, respectively; P<0.001). At all root levels, the distensibility was reduced in group A (P<0.001). Systolic contact of aortic cusps and wall occurred only in group A.
Conclusions—Near-normal opening and closing characteristics can be achieved by a technique that preserves the shape and independent mobility of the sinuses of Valsalva.
Key Words: aorta • valves • surgery • echocardiography
This article has been cited by other articles:
 |
|
 |
|
  2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 N. D. Patel, E. S. Weiss, D. E. Alejo, L. U. Nwakanma, J. A. Williams, H. C. Dietz, P. J. Spevak, V. L. Gott, L. A. Vricella, and D. E. Cameron Aortic root operations for marfan syndrome: a comparison of the bentall and valve-sparing procedures. Ann. Thorac. Surg., June 1, 2008; 85(6): 2003 - 2011. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. David Aortic Valve Repair and Aortic Valve Sparing Operations Card. Surg. Adult, January 1, 2008; 3(2008): 935 - 948. [Full Text]
|
|
|
|
|
|
M. J. Davidson and D. S. Baim Percutaneous Aortic Valve Interventions Card. Surg. Adult, January 1, 2008; 3(2008): 963 - 971. [Full Text]
|
|
|
|
 |
|
 D. Aicher, F. Langer, H. Lausberg, B. Bierbach, and H.-J. Schafers Aortic root remodeling: Ten-year experience with 274 patients. J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 909 - 915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rama, S. Rubin, N. Bonnet, and I. Gandjbakhch New Technique of Aortic Root Reconstruction With Aortic Valve Annuloplasty in Ascending Aortic Aneurysm Ann. Thorac. Surg., May 1, 2007; 83(5): 1908 - 1910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Lansac, I. Di Centa, F. Raoux, R. Raffoul, N. Al Attar, A. Rama, C. Acar, and P. Nataf Aortic annuloplasty: towards a standardized approach of conservative aortic valve surgery MMCTS, March 29, 2007; 2007(0329): 1958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Moritz, P. Risteski, S. Dogan, H. Macit, B. Akbulut, A. Zierer, and T. Aybek Six stitches to create a neosinus in David-type aortic root resuspension J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 560 - 562. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Miller Valve-Sparing Aortic Root Replacement: Current State of the Art and Where Are We Headed? Ann. Thorac. Surg., February 1, 2007; 83(2): S736 - S739. [Full Text] [PDF]
|
|
|
|
|
|
A. W. Erasmi, H.-H. Sievers, J.F. M. Bechtel, T. Hanke, U. Stierle, and M. Misfeld Remodeling or Reimplantation for Valve-Sparing Aortic Root Surgery? Ann. Thorac. Surg., February 1, 2007; 83(2): S752 - S756. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Gerosa, S. Pontarollo, S. Iliceto, and F. di Marco An alternative technique for aortic root remodeling in patients with bicuspid aortic valve J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 249 - 250. [Full Text] [PDF]
|
|
|
|
|
|
D. Pacini, F. Settepani, R. De Paulis, A. Loforte, S. Nardella, D. Ornaghi, R. Gallotti, L. Chiariello, and R. Di Bartolomeo Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann. Thorac. Surg., September 1, 2006; 82(3): 865 - 871. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Nataf and E Lansac Dilation of the thoracic aorta: medical and surgical management. Heart, September 1, 2006; 92(9): 1345 - 1352. [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
|
|
N. D. Patel, J. A. Williams, C. J. Barreiro, B. T. Bethea, T. P. Fitton, H. C. Dietz, J. A.C. Lima, P. J. Spevak, V. L. Gott, L. A. Vricella, et al. Valve-Sparing Aortic Root Replacement: Early Experience With the De Paulis Valsalva Graft in 51 Patients Ann. Thorac. Surg., August 1, 2006; 82(2): 548 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Fries, T. Graeter, D. Aicher, H. Reul, C. Schmitz, M. Bohm, and H.-J. Schafers In vitro comparison of aortic valve movement after valve-preserving aortic replacement J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 32 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Di Bartolomeo, D. Pacini, S. Martin-Suarez, A. Loforte, A. Dell'Amore, M. Ferlito, G. Bracchetti, and G. Bozzetti Valsalva prosthesis in aortic valve-sparing operations Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 294 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Lansac, I. Di Centa, N. Bonnet, P. Leprince, A. Rama, C. Acar, A. Pavie, and I. Gandjbakhch Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure? Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 537 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Vricella, J. A. Williams, W. J. Ravekes, K. W. Holmes, H. C. Dietz, V. L. Gott, and D. E. Cameron Early Experience With Valve-Sparing Aortic Root Replacement in Children Ann. Thorac. Surg., November 1, 2005; 80(5): 1622 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Albes, U. A. Stock, and M. Hartrumpf Restitution of the Aortic Valve: What is New, What is Proven, and What is Obsolete? Ann. Thorac. Surg., October 1, 2005; 80(4): 1540 - 1549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Erasmi, H.-H. Sievers, M. Scharfschwerdt, T. Eckel, and M. Misfeld In vitro hydrodynamics, cusp-bending deformation, and root distensibility for different types of aortic valve-sparing operations: Remodeling, sinus prosthesis, and reimplantation J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1044 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. P. Urbanski Valve-Sparing Aortic Root Repair With Patch Technique Ann. Thorac. Surg., September 1, 2005; 80(3): 839 - 843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kallenbach, M. Karck, D. Pak, R. Salcher, N. Khaladj, R. Leyh, C. Hagl, and A. Haverich Decade of Aortic Valve Sparing Reimplantation: Are We Pushing the Limits Too Far? Circulation, August 30, 2005; 112(9_suppl): I-253 - I-259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Markl, M. T. Draney, D. C. Miller, J. M. Levin, E. E. Williamson, N. J. Pelc, D. H. Liang, and R. J. Herfkens Time-resolved three-dimensional magnetic resonance velocity mapping of aortic flow in healthy volunteers and patients after valve-sparing aortic root replacement J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 456 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Lansac, I. Di Centa, S. Varnous, A. Rama, F. Jault, C. M.G. Duran, C. Acar, A. Pavie, and I. Gandjbakhch External Aortic Annuloplasty Ring for Valve-Sparing Procedures Ann. Thorac. Surg., January 1, 2005; 79(1): 356 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Demers and D. C. Miller Simple Modification of "T. David-V" Valve-Sparing Aortic Root Replacement to Create Graft Pseudosinuses Ann. Thorac. Surg., October 1, 2004; 78(4): 1479 - 1481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui, H. Izumoto, M. Nasu, and K. Kawazoe Perioperative changes in dynamic aortic root morphology after Yacoub's root remodeling and concomitant aortic annuloplasty Interactive CardioVascular and Thoracic Surgery, September 1, 2004; 3(3): 465 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. E. Kvitting, T. Ebbers, L. Wigstrom, J. Engvall, C. L. Olin, and A. F. Bolger Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: Implications for aortic valve-sparing surgery J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1602 - 1607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Furukawa, H. Ohteki, Z.-L. Cao, Y. Narita, Y. Okazaki, S. Ohtsubo, and T. Itoh Evaluation of native valve-sparing aortic root reconstruction with direct imaging-- reimplantation or remodeling? Ann. Thorac. Surg., May 1, 2004; 77(5): 1636 - 1641. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Yacoub and L. H. Cohn Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part II Circulation, March 9, 2004; 109(9): 1064 - 1072. [Full Text] [PDF]
|
|
|
|
|
|
A. W. Erasmi, U. Stierle, J.F. M. Bechtel, C. Schmidtke, H. H. Sievers, and E. G. Kraatz Up to 7 years' experience with valve-sparing aortic root remodeling/reimplantation for acute type a dissection Ann. Thorac. Surg., July 1, 2003; 76(1): 99 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Handke, G. Heinrichs, F. Beyersdorf, M. Olschewski, C. Bode, and A. Geibel In vivo analysis of aortic valve dynamics by transesophageal 3-dimensional echocardiography with high temporal resolution J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1412 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Miller Valve-sparing aortic root replacement in patients with the Marfan syndrome J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 773 - 778. [Full Text] [PDF]
|
|
|
|
|
|
N. C. de Oliveira, T. E. David, J. Ivanov, S. Armstrong, M. J. Eriksson, H. Rakowski, and G. Webb Results of surgery for aortic root aneurysm in patients with Marfan syndrome J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 789 - 796. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kallenbach, C. Hagl, T. Walles, R. G. Leyh, K. Pethig, A. Haverich, and W. Harringer Results of valve-sparing aortic root reconstruction in 158 consecutive patients Ann. Thorac. Surg., December 1, 2002; 74(6): 2026 - 2033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Lansac, H.S. Lim, Y. Shomura, K.H. Lim, N.T. Rice, W. Goetz, C. Acar, and C.M.G. Duran A four-dimensional study of the aortic root dynamics Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 497 - 503. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Leyh, S. Fischer, K. Kallenbach, T. Kofidis, K. Pethig, W. Harringer, and A. Haverich High Failure Rate After Valve-sparing Aortic Root Replacement Using the "Remodeling Technique" in Acute Type A Aortic Dissection Circulation, September 24, 2002; 106(12_suppl_1): I-229 - I-233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. De Paulis, G. M. De Matteis, P. Nardi, R. Scaffa, C. Bassano, and L. Chiariello Analysis of valve motion after the reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit Ann. Thorac. Surg., July 1, 2002; 74(1): 53 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. De Paulis, G. M. De Matteis, P. Nardi, R. Scaffa, M. M. Buratta, and L. Chiariello Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit Ann. Thorac. Surg., August 1, 2001; 72(2): 487 - 494. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kallenbach, K. Pethig, M. Schwarz, A. Milz, A. Haverich, and W. Harringer Valve sparing aortic root reconstruction versus composite replacement - perioperative course and early complications Eur. J. Cardiothorac. Surg., July 1, 2001; 20(1): 77 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Zehr Reply J. Thorac. Cardiovasc. Surg., June 1, 2001; 121(6): 1220 - 1221. [Full Text] [PDF]
|
|
|
|
|
|
M. J. Thubrikar, F. Robicsek, G. G. Gong, and B. L. Fowler A new aortic root prosthesis with compliant sinuses for valve-sparing operations Ann. Thorac. Surg., May 1, 2001; 71 (2007): S318 - S322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Zehr, M. J. Thubrikar, G. G. Gong, J. R. Headrick, and F. Robicsek Clinical introduction of a novel prosthesis for valve-preserving aortic root reconstruction for annuloaortic ectasia J. Thorac. Cardiovasc. Surg., October 1, 2000; 120(4): 692 - 698. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Leyh, C. Schmidtke, C. Bartels, and H.-H. Sievers Valve-sparing aortic root replacement (remodeling/reimplantation) in acute type A dissection Ann. Thorac. Surg., July 1, 2000; 70(1): 21 - 24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Schoof, A. C. Gittenberger-de Groot, E. de Heer, J. A. Bruijn, M. G. Hazekamp, and H. A. Huysmans Remodeling of the porcine pulmonary autograft wall in the aortic position J. Thorac. Cardiovasc. Surg., July 1, 2000; 120(1): 55 - 65. [Abstract] [Full Text] [PDF]
|
|