eComment: Aortic root distensibility in bioprostheses Free

Systolic aortic root distensibility augments the orifice area at the level of the aortic annulus. It reduces leaflet stress by blood stream and partially influences the bioprosthesis durability. Therefore, aortic root biomechanics research after implantation of various types of bioprostheses is of great importance.

The presented data [1] allow one to prefer a bioprosthesis Solo (Sorin, Italy) for its near-natural systolic distension, both at the level of the aortic annulus and at the sinotubular junction. This movement is due to the curved line of proximal valve anastomosis. Excessive extensibility at both levels of the Toronto SPV (St Jude Medical) bioprosthesis can be the reason for the development of the late insufficiency. Extensive motion at the level of aortic annulus is doubtful because of the circular proximal suture line. The presence of the stent in the Mitroflow (Sorin, Italy) valve makes systolic aortic annulus extension impossible. Probably the left ventricular outflow tract (LVOT) extension was observed in this case.

In our clinic, the stented xenopericardial bioprostheses BioLAB have been applied with good late results. Bioprostheses BioLAB were implanted in aortic position in 108 patients. At a follow-up of nine years, four reoperations (infective endocarditis) were required. We did not register any systolic expansion at the aortic annulus level. From the point of view of the laminar stream, we assume the auto- and allografts are most successful. They are also capable of aortic root distensibility because of the stretching of three arches of proximal suture line.

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