Computational finite element analyses to optimize graft sizing during aortic valve-sparing procedure.

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Computational Mechanics

Background:

• Aortic valve-sparing (AVS) surgery addresses ascending aorta dilatation and valve insufficiency.
• Optimizing Dacron graft type and size is crucial but debated.
• Patient-specific finite element analysis (FEA) has not been applied to predict AVS outcomes.

Purpose of the Study:

• To optimize Dacron graft size and shape for AVS using patient-specific FEA.
• To evaluate the predictive capability of FEA for AVS postoperative results.

Main Methods:

• Developed patient-specific mathematical models of the aortic root.
• Created FEA models for standard straight and Valsalva Dacron grafts (24-30 mm).
• Simulated AVS procedures and diastolic valve closure, assessing coaptation ratios (H(C)R, L(C)R) and central coaptation distance (D(C)).

Main Results:

• Increased graft size decreased H(C)R and L(C)R, with no significant difference between graft types.
• The Valsalva graft significantly reduced D(C) compared to the straight graft.
• Recommended a 30 mm straight graft or a 28 mm Valsalva graft for optimal patient outcome.

Conclusions:

• FEA is feasible and valuable for predicting AVS postoperative aortic root physiology.
• Patient-specific FEA can guide surgeons in selecting the optimal prosthesis size.
• This approach may enhance clinical decision-making in AVS procedures.