Abstract 828 Transvalvular stress hemodynamics of patients with Ross and aortic valve-sparing procedures show almost physiological results

Background:

Efforts to achieve physiologic aortic valve replacements are ongoing. The Ross procedure and David or Yacoub surgery (DY) are alternatives in suitable patients. The aim of the study was to compare the transvalvular hemodynamics of aortic autografts and DY and pulmonary homografts with their native valves during stress and recovery using stress echocardiography.

Methods and Results:

Stress-echocardiography was performed up to 75 watts in 45 patients with autografts, 17 patients with DY, and 31 healthy volunteers as well as 65 patients with homografts. At each exercise level and during recovery period, valvular flow, mean transvalvular pressure gradient, resistance and transvalvular stroke work were determined. All hemodynamic parameters did not differ significantly between aortic autograft, DY and controls during rest and recovery. Without correction of pressure recovery, pulmonary homografts demonstrated poorer hemodynamics with remarkably elevated extra stroke work and mean transvalvular pressure compared to native controls. When calculating pressure recovery (absolute and relative pressure recovery at rest 3.8+/-1.8 mmHg, 42.6+/-7.2%, respectively) and transvalvular energy loss (EL at rest 4.5+/-4.3 mmHg) the homograft hemodynamics reached the level of native controls.

Conclusions:

DY and autograft showed excellent flow hemodynamics comparable to native aortic valves with no detectable extra stroke work for the left ventricle. The same applies to the comparison of pulmonary homografts and controls, when pressure recovery was taken into account. Therefore, from the hemodynamic and energetic viewpoint, Ross and DY are unique techniques to restore physiological transvalvular flow conditions when performed by highly experienced surgeons.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Transvalvular stress hemodynamics of patients with Ross and aortic valve-sparing procedures show almost physiological results
C. Marquetand¹, A. Aboud², M. Hasfurther¹, C. Busch-Tilge², I. Eitel¹, S. Ensminger², G.-H. Reil³, U. Stierle⁴, J.-C. Reil¹
¹Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ²Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck; ³Klinik für Kardiologie, Klinikum Oldenburg AöR, Oldenburg; ⁴Praxis, Lübeck;
Background: Efforts to achieve physiologic aortic valve replacements are ongoing. The Ross procedure and David or Yacoub surgery (DY) are alternatives in suitable patients. The aim of the study was to compare the transvalvular hemodynamics of aortic autografts and DY and pulmonary homografts with their native valves during stress and recovery using stress echocardiography. Methods and Results: Stress-echocardiography was performed up to 75 watts in 45 patients with autografts, 17 patients with DY, and 31 healthy volunteers as well as 65 patients with homografts. At each exercise level and during recovery period, valvular flow, mean transvalvular pressure gradient, resistance and transvalvular stroke work were determined. All hemodynamic parameters did not differ significantly between aortic autograft, DY and controls during rest and recovery. Without correction of pressure recovery, pulmonary homografts demonstrated poorer hemodynamics with remarkably elevated extra stroke work and mean transvalvular pressure compared to native controls. When calculating pressure recovery (absolute and relative pressure recovery at rest 3.8+/-1.8 mmHg, 42.6+/-7.2%, respectively) and transvalvular energy loss (EL at rest 4.5+/-4.3 mmHg) the homograft hemodynamics reached the level of native controls. Conclusions: DY and autograft showed excellent flow hemodynamics comparable to native aortic valves with no detectable extra stroke work for the left ventricle. The same applies to the comparison of pulmonary homografts and controls, when pressure recovery was taken into account. Therefore, from the hemodynamic and energetic viewpoint, Ross and DY are unique techniques to restore physiological transvalvular flow conditions when performed by highly experienced surgeons.
https://dgk.org/kongress_programme/jt2022/aP1246.html