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Ann Thorac Surg 2003;75:2007
© 2003 The Society of Thoracic Surgeons

Correspondence

Compliance of aortic root conduit

Francis Robicsek, MD, PhDa, Mano J. Thubrikar, PhDb

a Department of Thoracic and, Cardiovascular Surgery, Carolinas Medical Center, 1001 Blythe Blvd, Suite 30, Charlotte, NC, USA
b Heineman Medical Research Laboratory, 1000 Blythe BoulevardCarolinas Medical Center, Charlotte, NC 28203, USA

e-mail: tjohn{at}sanger-clinic.com

To the Editor:

The report of De Paulis and coauthors [1] confirms our previous findings that in the course of valve-sparing ascending aortic replacements using grafts with a proximal bulge [2], which recreates compliant sinuses of Valsalva [3] significantly reduces the stress on the retained native aortic cusps [4].

Our experience with our two designs of "sinus"[2, 3] grafts includes 10 years of extensive in vitro, as well as 2 and a half years of clinical studies (Figure 1) [4]. We found that the elasticity of the recreated aortic root in these grafts indeed approaches that of the native aortic root. This compliance rests on two material components: the scalloped remnants of the aortic wall containing the cusps and the neosinuses created of vertically crimped Dacron. While we expect the aortic wall-remnant to maintain its compliance, we have to keep an open mind and follow closely the changes that may occur in the elasticity of the Dacron neosinuses. Based upon past experiences in vascular surgery it is our pessimistic prediction that these artificial "sinuses of Valsalva," like any other Dacron or similar material, may indeed lose some or all of their compliance either by ingrowth or by encapsulation of fibrous tissue. Time will tell.



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  		Fig 1. (Left) The Robicsek-Thubrikar compliant aortic sinus-graft. (Right) Intraoperative photograph showing the sinus-graft in place. (Reprinted from J Thorac Cardiovasc Surg, 120, Zehr et al, Clinical introduction of a novel prosthesis for valve-preserving aortic root reconstruction for annuloaortic ectasia, 692–8, Copyright 2000, with permission from The Society of Thoracic Surgeons [3].)

 
References

  1. De Paulis R., Matteis G.M., Nardi P., Scaffa R., Bassano C., Chiariello L. Analysis of valve motion after reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit. Ann Thorac Surg 2002;74:53-57.[Abstract/Free Full Text]
  2. Robicsek F. Ascending aortic prosthesis. United States Patent Office No. 5,139,515, August 18, 1992
  3. Zehr K.J., Thubrikar M.J., Gong G.G., Headrick J.R., Robicsek F. Clinical introduction of a novel prosthesis for valve-preserving aortic root reconstruction for annuloaortic ectasia. J Thorac Cardiovasc Surg 2000;120:692-698.[Abstract/Free Full Text]
  4. Beck A., Thubrikar M.J., Robicsek F. Stress analysis of the aortic valve with and without the sinuses of Valsalva. J Heart Valve Dis 2001;10:1-11.[Medline]



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