A Novel Device for Intraoperative Direct Visualization of a Pressurized Root in Aortic Valve Repair

Design and evaluation of valve interventions using ex vivo biomechanical modeling: the Stanford experience

The increase in prevalence of valvular heart disease coupled with an aging population has placed increased emphasis on durable valvular repair strategies. Despite many advances in valvular therapies, there has been little rigorous biomechanical evaluation and validation of existing repair strategies. Our research group engineered a novel 3D-printed, ex vivo heart simulator, which has allowed us to refine and innovate numerous surgical repair strategies with hemodynamic and biomechanical feedback in real time on explanted animal heart valves. Data obtained from this novel simulator have directly influenced clinical practice at our institution. It has also proven to be an outstanding platform for valvular device development. Herein, we will review our experience with ex vivo biomechanical simulation, subdivided into work on aortic valve pathology, mitral valve pathology, and novel devices.

Valve-sparing aortic root replacement: Strategies to avoid residual aortic regurgitation

Objective

The study objective was to identify quantitative criteria to avoid residual aortic valve regurgitation after valve-sparing aortic root replacement.

Methods

Between 2016 and 2023, 738 adult patients were recruited into the German Aortic Root Repair Registry. A total of 562 patients with datasets on aortic root measurements and tricuspid valve treated with reimplantation valve-sparing aortic root replacement were selected. End points were any grade of residual aortic valve regurgitation and postrepair coaptation height. Tested variables included procedural and anatomic characteristics, including length of cusp margins and geometric cusp heights.

Results

The optimal classifier predicting freedom from residual aortic valve regurgitation was cusp coaptation height 8 to 9 mm or more (sensitivity = 0.7-0.8). Annular downsizing alone was not useful to predict residual aortic valve regurgitation (P = .472, 95% area CI, 0.414-0.54). Patients with a mean free margin length of at least 45 mm and a sum of free margin lengths of at least 125 mm were more likely to present coaptation heights of at least 10 mm (R2 0.038, P = .006).

Conclusions

The target coaptation height after valve-sparing aortic root replacement should exceed 8 to 9 mm. Chances of achieving it can be estimated on the basis of a measurement of cusp quantity. If in doubt when inspecting a valve, numerical criteria can help with surgical decision-making in favor of or against a valve-sparing approach.

A conversation with the 2024 "Oriental Rising Star" awardee

Aiming at encouraging young talents to become dedicated surgeon-scientists in the field of thoracic and cardiovascular surgery, an "Oriental Rising Star Award" was established at the 32nd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery ("ASCVTS 2024") which was held in Wuhan, China, on May 23-26, 2024. The winner of the First Prize was Dr. Yuanjia Zhu from Stanford University, USA. Following the conclusion of the "ASCVTS 2024," Professor Song Wan, Chairman of the Scientific Committee of the "ASCVTS 2024," conducted an interview with Dr. Zhu. Their conversation is presented below.