• Mario Gaudino, Filippo Piatti, Christopher Lau, Francesco Sturla, Jonathan W Weinsaft, Luca Weltert, Emiliano Votta, Nicola Galea, Ilaria Chirichilli, Antonino Di Franco, Marco Francone, Carlo Catalano, Alberto Redaelli, Leonard N Girardi, and Ruggero De Paulis.
• Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY. Electronic address: mfg9004@med.cornell.edu.
• J. Thorac. Cardiovasc. Surg. 2019 Feb 1; 157 (2): 455-465.

ObjectivesThis study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses.MethodsWe enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group.ResultsPhysiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P < .001 vs control). In the ascending aorta, recreation of the sinuses resulted in significantly lower velocity and WSS than in the straight tubular graft (P < .001) and controls (P < .001), these alterations were attenuated in the mid-descending aorta. Incidence of abnormal WSS was markedly higher in the straight tube grafts than neosinus of Valsalva grafts.ConclusionsRe-creation of the sinuses of Valsalva during valve-sparing root replacement is associated with more physiologic flow and significantly lower WSS in the aortic root. Lower WSSs in the distal thoracic aorta is a novel finding with potential implications on distal aortic remodeling.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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