An expansible aortic ring for a physiological approach to conservative aortic valve surgery Emmanuel Lansac, MD, PhD, Isabelle Di Centa, MD, François.

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Presentation transcript:

An expansible aortic ring for a physiological approach to conservative aortic valve surgery Emmanuel Lansac, MD, PhD, Isabelle Di Centa, MD, François Raoux, MD, Neil Bulman-Fleming, Adrian Ranga, Aicha Abed, MSc, Maguette Ba, MD, Anthony Paolitto, Didier Letourneur, PhD, Anne Meddahi-Pellé, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 3, Pages 718-724 (September 2009) DOI: 10.1016/j.jtcvs.2009.05.024 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Clinical applications of aortic annuloplasty for conservative aortic valve surgery. A, Remodeling associated with a complete subvalvular aortic ring combining advantages of the original remodeling and reimplantation techniques. B, Double subvalvular and supravalvular external aortic annuloplasty by using open rings, standardizing the principles of the subvalvular and supravalvular plicating stitches. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 718-724DOI: (10.1016/j.jtcvs.2009.05.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Expansible aortic ring before implantation. A, Cut-away schematic diagram of the device showing its key components. B, Top: Before implantation, the ring is opened and mounted on a holder that is attached to the handle. The black indicator marks on the ring facilitate optimal suture placement. Bottom: After implantation, the ends of the ring are fastened. C, Scanning electronic microscope image showing a cross-section of the ring with its rectangular silicone core covered by a polyester sheath (insert). Scale bars = 200 μm. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 718-724DOI: (10.1016/j.jtcvs.2009.05.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Intracardiac ultrasonographic aortic root long-axis view: A preoperative; B, 6 months postoperative. 1, Aortic annular base diameter; 2, sinotubular junction diameter; 3, coaptation height. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 718-724DOI: (10.1016/j.jtcvs.2009.05.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Aortic rings at 6 months after implantation. A, Macroscopic aspect of the heart showing the 2 rings. No apparent calcifications were observed. B, Close-up of the implantation site. Arrows indicates the silicone core locations. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 718-724DOI: (10.1016/j.jtcvs.2009.05.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Histologic sections of the aortic ring 6 months after implantation. A, The silicone core was embedded in a fibrous area surrounded by polyester sheath included in the extracellular matrix. B, Scanning electron microscope image of the expansible ring 6 months after implantation. The ring is integrated in the extracellular matrix and embedded the silicone core. The insert shows a higher magnification of the polyester fibers. C, Close-up of polyester fibers (white rectangle in A; black arrows). D, Close-up of the fibrous area surrounding the silicone core (dotted square in A). Hematoxylin and eosin staining: m, matrix; f, fibrous zone. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 718-724DOI: (10.1016/j.jtcvs.2009.05.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions