The ideal theoretical graft oversizing in valve-sparing aortic operations with a standard tubular or a Valsalva graft

• Published in: European journal of cardio-thoracic surgery Vol. 28; no. 6; pp. 845 - 849
• Main Authors: Maselli, Daniele, Borelli, Gabriele, Amerini, Andrea, Bajona, Pietro, Bellieni, Luca, Croccia, Mariagrazia, Minzioni, Gaetano
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.12.2005; Elsevier Science
• Subjects: Adult; Aortic root sizing; Aortic Valve Insufficiency - surgery; Aortic valve reimplantation; Aortic valve-sparing operation; Biological and medical sciences; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Female; Humans; Male; Medical sciences; Middle Aged; Models, Cardiovascular; Pneumology; Prosthesis Design; Reference Values; Replantation - methods; Sinus of Valsalva - anatomy & histology; Sinus of Valsalva - diagnostic imaging; Sinus of Valsalva - surgery; Sinuses of Valsalva; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ultrasonography; Aortic valve reimplantation; Aortic root sizing; Aortic valve-sparing operation; Sinuses of Valsalva; Root; Theoretical study; Standard; Operation; Phlebology; Standards; Treatment; Surgery; Aorta; Graft; Circulatory system; Cardiology; Aortic valve
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.09.016

Objective: We sought to determine, by a mathematical model, the ideal theoretical degree of ascending aortic graft oversizing needed to obtain normal sinuses dimension in the reimplantation type of valve-sparing aortic operations. Methods: To define a normal-range value, size of sinuses of Valsalva was conventionally expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area (BLA), and measured in 50 healthy subjects. A mathematical relationship between aortic annulus diameter, aortic sinuses diameter and resulting BLA was defined. By simulating intra-operative scenarios, the effect of different degrees of a standard or Valsalva graft oversizing on BLA extension was tested. Results: The same degree of graft oversizing resulted in a bigger beyond leaflets area for the Valsalva graft than for a standard graft. Oversizing degrees exceeding +7 mm for a standard graft and +3 mm for the Valsalva graft resulted in a beyond leaflets area over normal limits. Results were expressed in a visual form as two different normograms, one for the standard graft and one for the Valsalva graft. Conclusions: A less pronounced graft oversizing is needed to achieve normal-range sinuses size when using a Valsalva graft, the ideal theoretical graft oversizing was +7 mm for a standard graft and +3 mm for the Valsalva graft, our normograms can be helpful in selecting a proper graft size when performing a valve-sparing aortic procedure.