Mario Gaudino1, Filippo Piatti2, Christopher Lau3, Francesco Sturla4, Jonathan W Weinsaft5, Luca Weltert6, Emiliano Votta2, Nicola Galea7, Ilaria Chirichilli6, Antonino Di Franco3, Marco Francone8, Carlo Catalano8, Alberto Redaelli2, Leonard N Girardi3, Ruggero De Paulis6. 1. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY. Electronic address: mfg9004@med.cornell.edu. 2. Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy. 3. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY. 4. 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy. 5. Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY. 6. Department of Cardiac Surgery, European Hospital, Rome, Italy. 7. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy. 8. Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
Abstract
OBJECTIVES: This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses. METHODS: We enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group. RESULTS: Physiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P < .001 vs control). In the ascending aorta, recreation of the sinuses resulted in significantly lower velocity and WSS than in the straight tubular graft (P < .001) and controls (P < .001), these alterations were attenuated in the mid-descending aorta. Incidence of abnormal WSS was markedly higher in the straight tube grafts than neosinus of Valsalva grafts. CONCLUSIONS: Re-creation of the sinuses of Valsalva during valve-sparing root replacement is associated with more physiologic flow and significantly lower WSS in the aortic root. Lower WSSs in the distal thoracic aorta is a novel finding with potential implications on distal aortic remodeling.
OBJECTIVES: This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses. METHODS: We enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group. RESULTS: Physiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P < .001 vs control). In the ascending aorta, recreation of the sinuses resulted in significantly lower velocity and WSS than in the straight tubular graft (P < .001) and controls (P < .001), these alterations were attenuated in the mid-descending aorta. Incidence of abnormal WSS was markedly higher in the straight tube grafts than neosinus of Valsalva grafts. CONCLUSIONS: Re-creation of the sinuses of Valsalva during valve-sparing root replacement is associated with more physiologic flow and significantly lower WSS in the aortic root. Lower WSSs in the distal thoracic aorta is a novel finding with potential implications on distal aortic remodeling.
Authors: Maria C Palumbo; Alberto Redaelli; Matthew Wingo; Katherine A Tak; Jeremy R Leonard; Jiwon Kim; Lisa Q Rong; Christine Park; Hannah W Mitlak; Richard B Devereux; Mary J Roman; Arindam RoyChoudury; Christopher Lau; Mario F L Gaudino; Leonard N Girardi; Jonathan W Weinsaft Journal: Eur J Cardiothorac Surg Date: 2022-03-24 Impact factor: 4.191