Aortic root performance after valve sparing procedure: a comparative finite element analysis

none8noneM. SONCINI, E. VOTTA, S. ZINICCHINO, V. BURRONE; A. MANGINI, M. LEMMA, C. ANTONA, A. REDAELLISoncini, Monica; Votta, Emiliano; S., Zinicchino; V., Burrone; A., Mangini; M., Lemma; C., Antona; Redaelli, ALBERTO CESARE LUIG

Aortic root performance after valve sparing procedure : a comparative finite element analysis

David and Yacoub sparing techniques are the most common procedures adopted for the surgical correction of aortic root aneurysms. These surgical procedures entail the replacement of the sinuses of Valsalva with a synthetic graft, inside which the cusps are re-suspended. Root replacement by a synthetic graft may result in altered valve behaviour both in terms of coaptation and stress distribution, thus leading to the failure of the correction. A finite element approach was used to investigate this phenomenon; four 3D models of the aortic root were developed to simulate the root in physiological, pathological and post-operative conditions after the two different surgical procedures. The physiological 3D geometrical model was developed on the basis of anatomical data obtained from echocardiographic images; it was then modified to obtain the pathological and post-operative models. The effectiveness of both techniques was assessed by comparison with the first two simulated conditions, in terms of stresses acting on the root, leaflet coaptation and interaction between leaflets and the graft during valve opening. Results show that both sparing techniques are able to restore aortic valve coaptation and to reduce stresses induced by the initial root dilation. Nonetheless, both techniques lead to altered leaflet kinematics, with more evident alterations after David repair

Finite element simulations of the physiological aortic root and valve sparing corrections.

A 3-D model of the aortic root was developed consisting of aortic valve, sinus of Valsalva and aortic duct. Through finite element modeling, the mechanical behavior of the valve was investigated simulating four different configurations: physiological (baseline), aneurysmatic and corrected with two different sparing techniques, named after David and Yacoub, respectively. These surgical procedures imply the replacement of the sinus of Valsalva with a synthetic graft, inside which the cusps are resuspended. The final goal of this study consisted in the assessment of the mechanical effects of sinuses aneurysm on the whole root, as well as the effectiveness of the two aforementioned techniques in restoring valve functionality and normal stress values on the root substructures. Based on the assumption of three-leaflet symmetry, only one third of the aortic root was modeled. Two cardiac cycles were simulated and the mechanical behavior of the aortic root was evaluated in terms of stress pattern, contact pressure and contact areas observed during leaflets coaptation and when contact between the leaflet and the graft occurs. Both the sparing techniques are able to restore coaptation of the aortic valve, but for the David procedure, contact between the leaflet and the graft wall was detected