Yuanjia Zhu1, Mateo Marin-Cuartas2, Matthew H Park3, Annabel M Imbrie-Moore3, Robert J Wilkerson4, Sarah Madira4, Danielle M Mullis4, Y Joseph Woo5. 1. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif. 2. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 3. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, Calif. 4. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif. 5. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif. Electronic address: joswoo@stanford.edu.
Abstract
OBJECTIVE: The inclusion technique was developed to reinforce the pulmonary autograft to prevent dilation after the Ross procedure. Anticommissural plication (ACP), a modification technique, can reduce graft size and create neosinuses. The objective was to evaluate pulmonary valve biomechanics using the inclusion technique in the Ross procedure with and without ACP. METHODS: Seven porcine and 5 human pulmonary autografts were harvested from hearts obtained from a meat abattoir and from heart transplant recipients and donors, respectively. Five additional porcine autografts without reinforcement were used as controls. The Ross procedure was performed using the inclusion technique with a straight polyethylene terephthalate graft. The same specimens were tested both with and without ACP. Hemodynamic parameter data, echocardiography, and high-speed videography were collected via the ex vivo heart simulator. RESULTS: Porcine autograft regurgitation was significantly lower after the use of inclusion technique compared with controls (P < .01). ACP compared with non-ACP in both porcine and human pulmonary autografts was associated with lower leaflet rapid opening velocity (3.9 ± 2.4 cm/sec vs 5.9 ± 2.4 cm/sec; P = .03; 3.5 ± 0.9 cm/sec vs 4.4 ± 1.0 cm/sec; P = .01), rapid closing velocity (1.9 ± 1.6 cm/sec vs 3.1 ± 2.0 cm/sec; P = .01; 1.8 ± 0.7 cm/sec vs 2.2 ± 0.3 cm/sec; P = .13), relative rapid opening force (4.6 ± 3.0 vs 7.7 ± 5.2; P = .03; 3.0 ± 0.6 vs 4.0 ± 2.1; P = .30), and relative rapid closing force (2.5 ± 3.4 vs 5.9 ± 2.3; P = .17; 1.4 ± 1.3 vs 2.3 ± 0.6; P = .25). CONCLUSIONS: The Ross procedure using the inclusion technique demonstrated excellent hemodynamic parameter results. The ACP technique was associated with more favorable leaflet biomechanics. In vivo validation should be performed to allow direct translation to clinical practice.
OBJECTIVE: The inclusion technique was developed to reinforce the pulmonary autograft to prevent dilation after the Ross procedure. Anticommissural plication (ACP), a modification technique, can reduce graft size and create neosinuses. The objective was to evaluate pulmonary valve biomechanics using the inclusion technique in the Ross procedure with and without ACP. METHODS: Seven porcine and 5 human pulmonary autografts were harvested from hearts obtained from a meat abattoir and from heart transplant recipients and donors, respectively. Five additional porcine autografts without reinforcement were used as controls. The Ross procedure was performed using the inclusion technique with a straight polyethylene terephthalate graft. The same specimens were tested both with and without ACP. Hemodynamic parameter data, echocardiography, and high-speed videography were collected via the ex vivo heart simulator. RESULTS: Porcine autograft regurgitation was significantly lower after the use of inclusion technique compared with controls (P < .01). ACP compared with non-ACP in both porcine and human pulmonary autografts was associated with lower leaflet rapid opening velocity (3.9 ± 2.4 cm/sec vs 5.9 ± 2.4 cm/sec; P = .03; 3.5 ± 0.9 cm/sec vs 4.4 ± 1.0 cm/sec; P = .01), rapid closing velocity (1.9 ± 1.6 cm/sec vs 3.1 ± 2.0 cm/sec; P = .01; 1.8 ± 0.7 cm/sec vs 2.2 ± 0.3 cm/sec; P = .13), relative rapid opening force (4.6 ± 3.0 vs 7.7 ± 5.2; P = .03; 3.0 ± 0.6 vs 4.0 ± 2.1; P = .30), and relative rapid closing force (2.5 ± 3.4 vs 5.9 ± 2.3; P = .17; 1.4 ± 1.3 vs 2.3 ± 0.6; P = .25). CONCLUSIONS: The Ross procedure using the inclusion technique demonstrated excellent hemodynamic parameter results. The ACP technique was associated with more favorable leaflet biomechanics. In vivo validation should be performed to allow direct translation to clinical practice.
Authors: Yuanjia Zhu; Annabel M Imbrie-Moore; Matthew H Park; Michael J Paulsen; Hanjay Wang; John W MacArthur; Y Joseph Woo Journal: Ann Thorac Surg Date: 2020-07-11 Impact factor: 4.330
Authors: M Mostafa Mokhles; Dimitris Rizopoulos; Eleni R Andrinopoulou; Jos A Bekkers; Jolien W Roos-Hesselink; Emmanuel Lesaffre; Ad J J C Bogers; Johanna J M Takkenberg Journal: Eur Heart J Date: 2012-06-22 Impact factor: 29.983
Authors: Laurent de Kerchove; Jean Rubay; Agnès Pasquet; Alain Poncelet; Caroline Ovaert; Manuel Pirotte; Michel Buche; William D'Hoore; Philippe Noirhomme; Gebrine El Khoury Journal: Ann Thorac Surg Date: 2009-01 Impact factor: 4.330
Authors: Changtian Wang; Mario Lachat; Evelyn Regar; Ludwig Karl von Segesser; Francesco Maisano; Enrico Ferrari Journal: Interact Cardiovasc Thorac Surg Date: 2018-06-01
Authors: Yuanjia Zhu; Annabel M Imbrie-Moore; Michael J Paulsen; Bryant Priromprintr; Matthew H Park; Hanjay Wang; Haley J Lucian; Justin M Farry; Y Joseph Woo Journal: J Cardiovasc Transl Res Date: 2020-06-03 Impact factor: 4.132
Authors: Victoria M Stoll; Aaron T Hess; Christopher T Rodgers; Malenka M Bissell; Petter Dyverfeldt; Tino Ebbers; Saul G Myerson; Carl-Johan Carlhäll; Stefan Neubauer Journal: Circ Cardiovasc Imaging Date: 2019-05 Impact factor: 7.792
Authors: Yuanjia Zhu; Annabel M Imbrie-Moore; Michael J Paulsen; Matthew H Park; Nicholas A Tran; Y Joseph Woo Journal: Ann Thorac Surg Date: 2022-02-22 Impact factor: 5.102