Re-creation of sinuses is important for sparing the aortic valve: A finiteelement study

Objective: The treatment of choice for aortic valve insufficiency due to ro ot dilatation has become root replacement with aortic valve sparing. Howeve r, root replacement with a synthetic graft may result in altered valve stre sses. The purpose of this study was to compare the stress/strain patterns i n the spared aortic valve in different root replacement procedures by means of finite element modeling. Methods: Our finite element model of the normal human root and valve was mo dified to simulate and evaluate three surgical techniques: (1) "cylindrical " graft sutured below the valve at the anulus, (2) "tailored" graft sutured just above the valve, and (3) "pseudosinus" graft, tailored and sutured be low the valve at the anulus. Simulated diastolic pressures were applied, an d stresses and strains were calculated for the valve, root, and graft. Leaf let coaptation was also quantified. Results: All three root replacement models demonstrated significantly alter ed leaflet stress patterns as compared with normal patterns. The cylindrica l model showed the greatest increases in stress (16%-173%) and strain (10%- 98%), followed by the tailored model (stress +10%-157%, strain +9%-36%). Th e pseudosinus model showed the smallest increase in stress (9%-28%) and str ain (2%-31%), and leaflet coaptation was closest to normal. Conclusion: Valve-sparing techniques that allow the potential for sinus spa ce formation (tailored, pseudosinus) result in simulated leafier stresses t hat are closer to normal than the cylindrical technique. Normalized leaflet stresses in the clinical setting may result in improved longevity of the s pared valve.