Aortic root and valve relationships. Impact on surgical repair

A surgical procedure has recently been described for patients with aortic incompetence caused by annular dilation, but with normal aortic leaflets. The dilated aortic root is replaced with a Dacron graft, and the native aortic valve is resuspended within the graft. Matching the size and shape of the graft to the size of the leaflets may have significant effects on valve closure and leaflet stress and thus on the longevity of the repair. To define the relationship of native aortic root structure to leaflet size, we morphologically examined normal human aortic roots (n = 10) and valve leaflets and applied mathematic analyses to the results. Our data show that the root has a consistent shape with varying size and that there is a definable mathematic relationship between root diameter and clinically measurable leaflet dimensions. We derived an equation that allows calculation of the appropriate diameter of the root at the sinus of Valsalva level from leaflet heights and perimeters. The diameter of the graft at the sinotubular junction and base should follow the relationship of the normalized root dimensions, either by tailoring of the graft or by new graft design. The current data imply that the graft should incorporate sinuses for proper valve closure and for sharing stress with the leaflets. Application of these results will allow prosthetic graft design to more closely resemble the native aorta. These new grafts should improve physiologic function of the valve, reduce leaflet stress, and increase the durability of the repair.