Abstract

Purpose

The valve-sparing aortic root replacement (VSARR) procedure was developed to preserve the aortic valve apparatus to replace aneurysmal aortic roots with synthetic grafts and to eliminate associated aortic regurgitation (AR). However, residual post-repair AR is not uncommon and has been found to be associated with recurrent AR and future reoperation.

Methods

We designed and manufactured a 3D-printed, external adjustable symmetrically extensible (EASE) aortic annuloplasty ring that can symmetrically reduce the aortic annulus diameter via a radial constriction, compliant mechanism. An ex vivo porcine VSARR model with annular dilation and AR was developed (n = 4) and used for hemodynamic, echocardiography, and high-speed videography data collection.

Results

After ring annuloplasty repair using the EASE aortic ring, the regurgitant fraction decreased from 23.6 ± 6.9% from the VSARR model to 7.4 ± 5.6% (p = 0.05), which was similar to that measured from baseline with a regurgitant fraction of 10.2 ± 3.9% (p = 0.34). The leaflet coaptation height after annuloplasty repair also significantly increased from that measured in VSARR model (0.4 ± 0.1 cm) to 0.9 ± 0.1 cm (p = 0.0004), a level similar to that measured in baseline (1.1 ± 0.1 cm, p = 0.28).

Conclusion

Using an ex vivo VSARR model, the EASE ring successfully reduced AR by reducing the annular diameter and improving leaflet coaptation. With its broad applicability and ease of use, this device has the potential to have a significant impact on patients suffering worldwide from AR due to root aneurysms.

中文翻译：

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3D 打印外部可调对称可伸展 (EASE) 主动脉瓣环成形术环，用于根部修复和主动脉瓣反流

摘要

目的

保留瓣膜的主动脉根部置换术 (VSARR) 手术的目的是保留主动脉瓣装置，用合成移植物替换动脉瘤主动脉根部，并消除相关的主动脉瓣反流 (AR)。然而，修复后残留的 AR 并不罕见，并且已发现与复发性 AR 和未来的再次手术有关。

方法

我们设计并制造了 3D 打印的外部可调节对称可伸展 (EASE) 主动脉瓣环成形术环，它可以通过径向收缩、顺应机制对称地减小主动脉瓣环直径。开发了具有环状扩张和 AR 的离体猪 VSARR 模型 ( n  = 4) 并用于血流动力学、超声心动图和高速摄像数据收集。

结果

使用 EASE 主动脉环进行环成形术修复后，返流分数从 VSARR 模型的 23.6 ± 6.9% 降至 7.4 ± 5.6% ( p  = 0.05)，与基线测量的值相似，返流分数为 10.2 ± 3.9 %（p  = 0.34）。瓣环成形术修复后的小叶接合高度也从 VSARR 模型中测量的 (0.4 ± 0.1 cm) 显着增加到 0.9 ± 0.1 cm ( p  = 0.0004)，与基线测量的水平相似 (1.1 ± 0.1 cm, p  = 0.28) ）。

结论

使用离体 VSARR 模型，EASE 环通过减小环直径和改善小叶接合成功地减少了 AR。凭借其广泛的适用性和易用性，该设备有可能对全世界因根动脉瘤而患有 AR 的患者产生重大影响。