Clinical introduction of a novel prosthesis for valve-preserving aortic root reconstruction for annuloaortic ectasia

Objective: Most patients with annuloaortic ectasia are young. They are at r isk for complications related to a lifetime of anticoagulation when composi te grafts containing mechanical valves are used for reconstruction. The maj ority of patients have near normal valve cusps. Valve-preserving techniques have been developed to maintain valve function and avoid anticoagulation, The eddy currents occurring within the sinuses of Valsalva in the natural a ortic root have been shown to be important in the smooth, gradual, and gent le closure of the valve. Compliance of the sinuses is important in reducing stress in the leaflets. A novel ascending aortic prosthesis with "built in " compliant sinuses (Robicsek-Thubrikar graft) was developed for clinical a ortic root replacement. Methods: Woven Dacron tubes were used to make the prostheses. Three precise ly measured square pieces were cut to make the expandable, individual sinus es. Sewing the individual neo-sinuses to a scalloped end of the Dacron tube graft created the neo-sinotubular junction and sinotubular ridge. Five pat ients with annuloaortic ectasia underwent valve-preserving aortic root reco nstruction. Results: All intraoperative transesophageal echocardiographic images after the valve-preserving procedure showed a normal appearing root with 10% radi al expansion of each sinus in systole. The space between the cusps and neo- sinus wall in systole was normal. No patient has more than mild aortic regu rgitation. Conclusions: Valve-preserving aortic root reconstruction with a novel Dacro n prosthesis with compliant "built in" sinuses re-establishes normal aortic root geometry with near normal valve motion. This may enhance the durabili ty of the valve-preserving operation.