Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective
Objective: The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves. Methods: In addition to a constructed unicuspid aortic valve disease model, 3 representative groups—free-edge length to aortic diame...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273624002560 |
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| author | Perry S. Choi, MD Amit Sharir, BS Yoshikazu Ono, MD Masafumi Shibata, MD Alexander D. Kaiser, PhD Yellappa Palagani, PhD Alison L. Marsden, PhD Michael R. Ma, MD |
| author_facet | Perry S. Choi, MD Amit Sharir, BS Yoshikazu Ono, MD Masafumi Shibata, MD Alexander D. Kaiser, PhD Yellappa Palagani, PhD Alison L. Marsden, PhD Michael R. Ma, MD |
| author_sort | Perry S. Choi, MD |
| collection | DOAJ |
| description | Objective: The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves. Methods: In addition to a constructed unicuspid aortic valve disease model, 3 representative groups—free-edge length to aortic diameter ratio 1.2, 1.57, and 1.8—were replicated in explanted porcine aortic roots (n = 3) by adjusting native free-edge length with bovine pericardium. Each group was 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 used to compare outcomes across groups. Results: The diseased control group had a mean transvalvular gradient of 28.3 ± 5.5 mm Hg, regurgitation fraction of 29.6% ± 8.0%, and orifice area of 1.03 ± 0.15 cm2. In ex vivo analysis, all repair groups had improved regurgitation and transvalvular gradient compared with the diseased control group (P < .001). Free-edge length to aortic diameter of 1.8 had the highest amount of regurgitation among the repair groups (P < .001) and 1.57 the least (P < .001). Free-edge length to aortic diameter of 1.57 also exhibited the lowest mean gradient (P < .001) and the largest orifice area (P < .001). Conclusions: Free-edge length to aortic diameter ratio significantly impacts valve function in bicuspidization repair of congenitally diseased aortic valves. As the ratio departs from 1.57 in either direction, effective orifice area decreases and both transvalvular gradient and regurgitation fraction increase. |
| format | Article |
| id | doaj-art-c1be7404d01545efadb38b2f194354dd |
| institution | OA Journals |
| issn | 2666-2736 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj-art-c1be7404d01545efadb38b2f194354dd2025-08-20T01:56:20ZengElsevierJTCVS Open2666-27362024-12-012239540410.1016/j.xjon.2024.09.008Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspectivePerry S. Choi, MD0Amit Sharir, BS1Yoshikazu Ono, MD2Masafumi Shibata, MD3Alexander D. Kaiser, PhD4Yellappa Palagani, PhD5Alison L. Marsden, PhD6Michael R. Ma, MD7Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, Calif; Cardiovascular Institute, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, Calif; Cardiovascular Institute, Stanford University, Palo Alto, Calif; Department of Bioengineering, Stanford University, Palo Alto, Calif; Institute for Computational & Mathematical Engineering, Stanford University, Palo Alto, CalifDivision of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, Calif; Cardiovascular Institute, Stanford University, Palo Alto, Calif; Address for reprints: Michael R. Ma, MD, Falk Cardiovascular Research Bldg, Palo Alto, CA 94304.Objective: The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves. Methods: In addition to a constructed unicuspid aortic valve disease model, 3 representative groups—free-edge length to aortic diameter ratio 1.2, 1.57, and 1.8—were replicated in explanted porcine aortic roots (n = 3) by adjusting native free-edge length with bovine pericardium. Each group was 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 used to compare outcomes across groups. Results: The diseased control group had a mean transvalvular gradient of 28.3 ± 5.5 mm Hg, regurgitation fraction of 29.6% ± 8.0%, and orifice area of 1.03 ± 0.15 cm2. In ex vivo analysis, all repair groups had improved regurgitation and transvalvular gradient compared with the diseased control group (P < .001). Free-edge length to aortic diameter of 1.8 had the highest amount of regurgitation among the repair groups (P < .001) and 1.57 the least (P < .001). Free-edge length to aortic diameter of 1.57 also exhibited the lowest mean gradient (P < .001) and the largest orifice area (P < .001). Conclusions: Free-edge length to aortic diameter ratio significantly impacts valve function in bicuspidization repair of congenitally diseased aortic valves. As the ratio departs from 1.57 in either direction, effective orifice area decreases and both transvalvular gradient and regurgitation fraction increase.http://www.sciencedirect.com/science/article/pii/S2666273624002560aortic valve repairbicuspidfree-edge lengthunicuspid |
| spellingShingle | Perry S. Choi, MD Amit Sharir, BS Yoshikazu Ono, MD Masafumi Shibata, MD Alexander D. Kaiser, PhD Yellappa Palagani, PhD Alison L. Marsden, PhD Michael R. Ma, MD Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective JTCVS Open aortic valve repair bicuspid free-edge length unicuspid |
| title | Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective |
| title_full | Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective |
| title_fullStr | Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective |
| title_full_unstemmed | Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective |
| title_short | Combined simulation and ex vivo assessment of free-edge length in bicuspidization repair for congenital aortic valve diseaseCentral MessagePerspective |
| title_sort | combined simulation and ex vivo assessment of free edge length in bicuspidization repair for congenital aortic valve diseasecentral messageperspective |
| topic | aortic valve repair bicuspid free-edge length unicuspid |
| url | http://www.sciencedirect.com/science/article/pii/S2666273624002560 |
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