Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective
Objective: To investigate the effect of graft sizing on valve performance in valve-sparing aortic root replacement for bicuspid aortic valve. Methods: In addition to a diseased control model, 3 representative groups—free-edge length to aortic/graft diameter (FELAD) ratio <1.3, 1.5 to 1.64, and &g...
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Elsevier
2024-06-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724001603 |
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| author | Perry S. Choi, MD Amit Sharir, BA Yoshikazu Ono, MD Masafumi Shibata, MD Alexander D. Kaiser, PhD Yuanjia Zhu, MD, PhD Alison L. Marsden, PhD Y. Joseph Woo, MD Michael R. Ma, MD Joon Bum Kim, MD, PhD |
| author_facet | Perry S. Choi, MD Amit Sharir, BA Yoshikazu Ono, MD Masafumi Shibata, MD Alexander D. Kaiser, PhD Yuanjia Zhu, MD, PhD Alison L. Marsden, PhD Y. Joseph Woo, MD Michael R. Ma, MD Joon Bum Kim, MD, PhD |
| author_sort | Perry S. Choi, MD |
| collection | DOAJ |
| description | Objective: To investigate the effect of graft sizing on valve performance in valve-sparing aortic root replacement for bicuspid aortic valve. Methods: In addition to a diseased control model, 3 representative groups—free-edge length to aortic/graft diameter (FELAD) ratio <1.3, 1.5 to 1.64, and >1.7—were replicated in explanted porcine aortic roots (n = 3) using straight grafts sized respective to the native free-edge length. They were run on a validated ex vivo univentricular system under physiological parameters for 20 cycles. All groups were tested within the same aortic root to minimize inter-root differences. Outcomes included transvalvular gradient, regurgitation fraction, and orifice area. Linear mixed effects model and pairwise comparisons were employed to compare outcomes across groups. Results: The diseased control had mean transvalvular gradient 10.9 ± 6.30 mm Hg, regurgitation fraction 32.5 ± 4.91%, and orifice area 1.52 ± 0.12 cm2. In ex vivo analysis, all repair groups had improved regurgitation compared with control (P < .001). FELAD <1.3 had the greatest amount of regurgitation among the repair groups (P < .001) and 1.5-1.64 the least (P < .001). FELAD <1.3 and >1.7 exhibited greater mean gradient compared with both control and 1.5 to 1.64 (P < .001). Among the repair groups, 1.5 to 1.64 had the largest orifice area, and >1.7 the smallest (P < .001). Conclusions: For a symmetric bicuspid aortic valve, performance after valve-sparing aortic root replacement shows a bimodal distribution across graft size. As the FELAD ratio departs from 1.5 to 1.64 in either direction, significant increases in transvalvular gradient are observed. FELAD <1.3 may also result in suboptimal improvement of baseline regurgitation. |
| format | Article |
| id | doaj-art-b0afcbb5f44e459bbe2355aaf54370f6 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-b0afcbb5f44e459bbe2355aaf54370f62025-08-20T03:38:24ZengElsevierJTCVS Techniques2666-25072024-06-01251710.1016/j.xjtc.2024.03.025Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspectivePerry S. Choi, MD0Amit Sharir, BA1Yoshikazu Ono, MD2Masafumi Shibata, MD3Alexander D. Kaiser, PhD4Yuanjia Zhu, MD, PhD5Alison L. Marsden, PhD6Y. Joseph Woo, MD7Michael R. Ma, MD8Joon Bum Kim, MD, PhD9Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, Calif; Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Address for reprints: Joon Bum Kim, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505, South Korea.Objective: To investigate the effect of graft sizing on valve performance in valve-sparing aortic root replacement for bicuspid aortic valve. Methods: In addition to a diseased control model, 3 representative groups—free-edge length to aortic/graft diameter (FELAD) ratio <1.3, 1.5 to 1.64, and >1.7—were replicated in explanted porcine aortic roots (n = 3) using straight grafts sized respective to the native free-edge length. They were run on a validated ex vivo univentricular system under physiological parameters for 20 cycles. All groups were tested within the same aortic root to minimize inter-root differences. Outcomes included transvalvular gradient, regurgitation fraction, and orifice area. Linear mixed effects model and pairwise comparisons were employed to compare outcomes across groups. Results: The diseased control had mean transvalvular gradient 10.9 ± 6.30 mm Hg, regurgitation fraction 32.5 ± 4.91%, and orifice area 1.52 ± 0.12 cm2. In ex vivo analysis, all repair groups had improved regurgitation compared with control (P < .001). FELAD <1.3 had the greatest amount of regurgitation among the repair groups (P < .001) and 1.5-1.64 the least (P < .001). FELAD <1.3 and >1.7 exhibited greater mean gradient compared with both control and 1.5 to 1.64 (P < .001). Among the repair groups, 1.5 to 1.64 had the largest orifice area, and >1.7 the smallest (P < .001). Conclusions: For a symmetric bicuspid aortic valve, performance after valve-sparing aortic root replacement shows a bimodal distribution across graft size. As the FELAD ratio departs from 1.5 to 1.64 in either direction, significant increases in transvalvular gradient are observed. FELAD <1.3 may also result in suboptimal improvement of baseline regurgitation.http://www.sciencedirect.com/science/article/pii/S2666250724001603bicuspid aortic valvevalve-sparing aortic root replacementDavid procedureaortic root replacementgraft sizefree-edge length |
| spellingShingle | Perry S. Choi, MD Amit Sharir, BA Yoshikazu Ono, MD Masafumi Shibata, MD Alexander D. Kaiser, PhD Yuanjia Zhu, MD, PhD Alison L. Marsden, PhD Y. Joseph Woo, MD Michael R. Ma, MD Joon Bum Kim, MD, PhD Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective JTCVS Techniques bicuspid aortic valve valve-sparing aortic root replacement David procedure aortic root replacement graft size free-edge length |
| title | Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective |
| title_full | Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective |
| title_fullStr | Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective |
| title_full_unstemmed | Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective |
| title_short | Effect of graft sizing in valve-sparing aortic root replacement for bicuspid aortic valve: The Goldilocks ratioCentral MessagePerspective |
| title_sort | effect of graft sizing in valve sparing aortic root replacement for bicuspid aortic valve the goldilocks ratiocentral messageperspective |
| topic | bicuspid aortic valve valve-sparing aortic root replacement David procedure aortic root replacement graft size free-edge length |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724001603 |
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