The aortic interleaflet triangles annuloplasty: a multidisciplinary appraisal.

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Computational Modeling

Background:

• Aortic interleaflets triangles annuloplasty (AITA) is a surgical technique to reduce the circumferential extent of interleaflet triangles.
• Stabilization of the aortic root functional unit (ARFU) is crucial for effective aortic valve repair.

Purpose of the Study:

• To quantify the effect of suture extent (SE) on aortic valve function during AITA.
• To establish general optimization criteria for AITA to improve ARFU stabilization.

Main Methods:

• A finite element model of the ARFU was modified to simulate ARFU dilation and AITA.
• Suture extent (SE) was systematically varied, quantifying regurgitant orifice (RO), leaflet co-aptation area (CA), and annular diameter (D(a)).
• Computational outcomes were validated against postoperative virtual basal ring echo data from 105 patients.

Main Results:

• Aortic regurgitant orifice (RA) and co-aptation area (CA) showed a linear dependence on SE.
• Optimal surgical results were predicted when SE was 48% of the interleaflet triangle height (ITH).
• Post-AITA, ARFU diameter decreased significantly, and leaflet co-aptation length (CL) increased from 2.73 ± 1.25 to 7.56 ± 2.36 mm (p<0.001).

Conclusions:

• Aortic interleaflets triangles annuloplasty (AITA) is a valuable technique for increasing leaflet co-aptation length in aortic valve repair.
• In silico models can predict the general principles of AITA but may not capture individual complexities.