Abstract
Ross operation might be a valid option for congenital and acquired left ventricular outflow tract disease in selected cases. As the pulmonary autograft is a living substitute for the aortic root that bioinspired the Ross operation, we have created an experimental animal model in which the vital capacity of the pulmonary autograft (PA) has been studied during physiological growth. The present study aims to determine any increased stresses in PA root and leaflet compared to the similar components of the native aorta. An animal model and a mathematical analysis using finite element analysis have been used for the purpose of this manuscript. The results of this study advance our understanding of the relative benefits of pulmonary autograft for the management of severe aortic valve disease. However, it launches a warning about the importance of the choice of the length of the conduits as mechanical deformation, and, therefore, potential failure, increases with the length of the segment subjected to stress. Understanding PA root and leaflet stresses is the first step toward understanding PA durability and the regions prone to dilatation, ultimately to refine the best implant technique.
Highlights
International guidelines and position papers from professional societies recommend Ross operation as a valid option for congenital and acquired left ventricular outflow tract disease in selected cases [1,2,3,4,5,6,7,8].Patients who benefit most from this procedure are children and young adults, women of childbearing age, and patients with contraindications to oral anticoagulants [9,10,11,12,13]
As a matter of fact, the finite element (FE) outcomes demonstrated that the interplay among material properties of the autograft and aorta, suture regions, geometry, and dilation constraints imposed by the annulus is crucial for determining the effects that actual stress concentrations, strain localization onsets, and deformation gradients have on the success of the Ross operation
Results of the FE analyses showed that the realistic response of the aorta-autograft ensemble cannot be captured by means of modeling simplifications, such as numerical simulations performed by taking into account the two vessels as separate entities [42,43,44]
Summary
International guidelines and position papers from professional societies recommend Ross operation as a valid option for congenital and acquired left ventricular outflow tract disease in selected cases [1,2,3,4,5,6,7,8].Patients who benefit most from this procedure are children and young adults, women of childbearing age, and patients with contraindications to oral anticoagulants [9,10,11,12,13]. The advantages are related to the somatic growth of the cardiovascular structures and with the avoidance of anticoagulants that would be required lifelong in the case of conventional mechanical prostheses [14,15,16,17,18]. As the pulmonary autograft is a living substitute for the aortic root that bioinspired the Ross operation, we have created an experimental animal model in which the vital capacity of the PA has been studied during physiological growth. We further revealed the mechanisms of growth, remodeling, and stress shielding of the reinforced PA by means of an experimental large animal model supported by an ex vivo mathematical and physical model [31,32,33,34,35,36,37,38]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
