PDF(Pubmed)
Abstract：
UNASSIGNED: To investigate the effect of graft sizing on valve performance in valve-sparing aortic root replacement for bicuspid aortic valve.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
摘要：
■为了研究在保留瓣膜的主动脉根部置换术中移植物尺寸对瓣膜性能的影响。
■除了疾病控制模型，3个代表性的组-自由边缘长度与主动脉/移植物直径(FELAD)之比<1.3、1.5至1.64和>1.7-使用尺寸对应于天然自由边缘长度的直移植物在外植体的猪主动脉根(n=3)中复制。它们在生理参数下在经过验证的离体单心室系统上运行20个周期。所有组均在相同的主动脉根内进行测试，以最大程度地减少根间差异。结果包括跨瓣梯度，返流分数，和孔口面积。采用线性混合效应模型和成对比较来比较各组的结果。
■患病对照的平均跨瓣压差为10.9±6.30mmHg，返流分数32.5±4.91%，孔口面积1.52±0.12cm2。在离体分析中，与对照组相比,所有修复组均有改善的反流(P<.001).FELAD<1.3修复组返流最多（P<.001），1.5-1.64最小（P<.001）。与对照和1.5-1.64相比，FELAD<1.3和>1.7表现出更大的平均梯度（P<.001）。在维修小组中，1.5至1.64的孔口面积最大，和>1.7最小（P<.001）。
■对于对称的二叶主动脉瓣，保留瓣膜的主动脉根部置换术后的性能显示出跨移植物大小的双峰分布。当FELAD比率在任一方向上偏离1.5至1.64时，观察到跨瓣膜梯度显着增加。FELAD<1.3也可能导致基线反流的次优改善。
■除了疾病控制模型，3个代表性的组-自由边缘长度与主动脉/移植物直径(FELAD)之比<1.3、1.5至1.64和>1.7-使用尺寸对应于天然自由边缘长度的直移植物在外植体的猪主动脉根(n=3)中复制。它们在生理参数下在经过验证的离体单心室系统上运行20个周期。所有组均在相同的主动脉根内进行测试，以最大程度地减少根间差异。结果包括跨瓣梯度，返流分数，和孔口面积。采用线性混合效应模型和成对比较来比较各组的结果。
■患病对照的平均跨瓣压差为10.9±6.30mmHg，返流分数32.5±4.91%，孔口面积1.52±0.12cm2。在离体分析中，与对照组相比,所有修复组均有改善的反流(P<.001).FELAD<1.3修复组返流最多（P<.001），1.5-1.64最小（P<.001）。与对照和1.5-1.64相比，FELAD<1.3和>1.7表现出更大的平均梯度（P<.001）。在维修小组中，1.5至1.64的孔口面积最大，和>1.7最小（P<.001）。
■对于对称的二叶主动脉瓣，保留瓣膜的主动脉根部置换术后的性能显示出跨移植物大小的双峰分布。当FELAD比率在任一方向上偏离1.5至1.64时，观察到跨瓣膜梯度显着增加。FELAD<1.3也可能导致基线反流的次优改善。
