Impact of aortic annular geometry on aortic valve insufficiency: Insights from a preclinical, ex vivo, porcine model Talal Al-Atassi, MD, MPH, Hadi Daood.

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Presentation transcript:

Impact of aortic annular geometry on aortic valve insufficiency: Insights from a preclinical, ex vivo, porcine model Talal Al-Atassi, MD, MPH, Hadi Daood Toeg, MD, MSc, Reza Jafar, PhD, Benjamin Sohmer, MD, MEd, Michel Labrosse, PhD, Munir Boodhwani, MD, MMSc The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 3, Pages 656-664.e1 (September 2015) DOI: 10.1016/j.jtcvs.2015.06.060 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Porcine aortic root and LHS. A, Fresh harvested porcine aortic root. B, Diamond-shaped patch used to enlarge STJ diameter. C, Aortic root mounted on LHS. D, Camera still image showing central coaptation defect resulting in AI. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Harvested aortic root with incorporated diamond-shaped patches. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Schematic of a splayed open heart and aortic root demonstrating the location of the diamond-shaped patches from the inside. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Effect of intervention on various AI parameters. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Correlation between STJ/VAJ ratio and regurgitant fraction. B, Correlation between STJ diameter increase and ERO. Definitions of AI severities were taken from the most recent valve guidelines.2 STJ, Sinotubular junction; VAJ, ventriculo-aortic junction; ERO, effective regurgitant orifice; AI, aortic insufficiency. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Finite element results illustrating the increase in AI and von Mises stress in the aortic leaflets when the STJ diameter is arbitrarily enlarged in increments of 2 mm compared with a control model of typical dimensions. Note that each model was studied in dynamics over a whole cardiac cycle; however, for comparison purposes, all the models are shown at the time in diastole when the pressure differential between the aortic and ventricular sides of the leaflets is maximal. STJ, Sinotubular junction. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Harvested aortic root with incorporated diamond-shaped patches. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 656-664.e1DOI: (10.1016/j.jtcvs.2015.06.060) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions