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Eur J Cardiothorac Surg 2005;27:90-93
© 2005 Elsevier Science NL

In-vitro study on the relationship between progressive sinotubular junction dilatation and aortic regurgitation for several stentless aortic valve substitutes

^a Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
^b Department of Anesthesiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany

Received 26 July 2004; received in revised form 28 August 2004; accepted 11 September 2004.

^* Corresponding author. Address: Klinik für Herzchirurgie, Ratzeburger Allee 160, 23564 Lübeck, Germany. Tel.: +49 451 500 2108; fax: +49 451 500 2051. (E-mail: axel.noetzold{at}gmx.de).

Objective: Stentless aortic valves are widely used due to their excellent hemodynamic properties. However, if the subcoronary implantation technique is used later dilatation of the sinotubular junction (STJ) can cause regurgitation. The aim of the study was to determine the dilatation tolerance of two commercially available stentless xenografts and fresh aortic and pulmonary roots against such dilatation. Methods: Four groups each comprising five specimens of fresh porcine aortic roots, pulmonary roots, Medtronic freestyle or Toronto SPV Xenografts were tested in a mock circulation using a special device for gradually increasing the diameter of the sinotubular junction. The smallest diameter D_r where regurgitation occurs was measured and correlated with the starting diameter D_a and expressed as per cent values. Opening and closing patterns were obtained by a high speed camera and flow characteristics were determined. Results: The highest dilatation tolerance of STJ was found in the fresh porcine aortic roots (165%±10) followed by fresh pulmonary roots (146%±12), the Freestyle (143%±4) and the SPV (132%±5) bioprostheses. All differences were significant with P0.05 except that between the fresh pulmonary roots and the two commercial available bioprostheses. Conclusions: Our results indicate that aortic homografts provide higher resistance against regurgitation induced by dilatation of the STJ than an autograft or the stentless xenografts, Freestyle xenograft followed by the Toronto SPV. The use of the full-root technique should be considered if aortic dilatation seems to be likely.

Key Words: Stentless porcine valve • Sinutubular junction • Allograft • Autograft • Implantation technique

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