Does Intercommissural Distance Shortening in Bicuspid Aortic Valve Repair Improve Valve Opening Area?

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Cardiac Valve Mechanics

Background:

• Standard bicuspid aortic valve (BAV) repair involves plicating the fused cusp, risking aortic stenosis.
• Improving cusp mobility by shortening intercommissural distance (ICD) was investigated in a BAV model.

Purpose of the Study:

• To examine the effect of shortening the ICD on increasing aortic valve area.
• To assess the impact of ICD shortening on hemodynamic parameters in a BAV model.

Main Methods:

• Created symmetrical BAV models in a neo-Valsalva graft using bovine pericardium.
• Utilized a pulsatile flow simulator to measure flow, leakage, pressure gradient, and aortic valve area as ICD was shortened.
• Analyzed an average of 18 measurements per model.

Main Results:

• Forward flow remained constant; leakage showed a slight, non-significant increase with ICD shortening (P = .17).
• Peak and mean transvalvular pressure gradients were significantly reduced by ICD shortening (P < .05 and P = .01, respectively).
• Aortic valve area significantly increased with ICD shortening (P < .01).

Conclusions:

• Shortening the ICD effectively increases aortic valve area and decreases pressure gradients in BAV models.
• Shortening the sinotubular junction diameter, equivalent to ICD, is vital for successful aortic valvuloplasty in BAV patients.