Subcoronary Technique for Orthotopic Implantation of Aortic Scaffold Reinforced with Polytetrafluoroethylene Strips in Sheep: A pilot Study

Hussam Al Hussein ,Marius Harpa,Adrian Man,Radu Deac,Ovidiu Simion Cotoi ,Klara Brînzaniuc ,Hamida Al Hussein ,Horațiu Suciu ,Carmen Sircuţa ,Dan Simionescu

doi:10.37358/mp.20.2.5356

Abstract

Over the time, numerous studies have been reported describing successful pulmonary valve replacement, either with xenografts or allografts, performed in sheep model. In contrast, comparable results have not been achieved yet for aortic valve replacement in orthotopic position, which involves a more difficult surgical technique, high hemodynamic demands for the implanted valve and poor survival of animals undergoing this kind of surgery. To our knowledge, in Romania, these were the first orthotopic allogeneic aortic root implantations using the subcoronary technique, carried out by our team. We established feasible perioperative, anesthetic and surgical protocols, which will be used in future studies to evaluate the in vivo functional performances of decellularized valves compared with autologous adipose derived stem cells seeded valves. Therefore, a unique research core was created, which is currently the only center of this kind in our country, by joining a multidisciplinary team consisting of biomedical engineers, cardiovascular surgeons, anesthesiologists, cardiologists, pathologists, microbiologists and veterinarians, who will continue the research activity in the field of tissue engineering and translate experimental results into clinical activity.

Highlights

Over the time, numerous studies have been reported describing successful pulmonary valve replacement, either with xenografts or allografts, performed in sheep model
Comparable results have not been achieved yet for aortic valve replacement (AVR) in orthotopic position, which involves a more difficult surgical technique, high hemodynamic demands for the implanted valve and poor survival of animals undergoing this kind of surgery [1]
The aim of this study was to describe the surgical technique used in sheep model for orthotopic implantation of decellularized aortic roots, in cardiopulmonary bypass, using the subcoronary technique, as well as the challenges encountered during the surgery and the premises that led to its choice

Summary

Introduction

Numerous studies have been reported describing successful pulmonary valve replacement, either with xenografts or allografts, performed in sheep model. There are surgical techniques for valvular annulus enlargement, but these require surgical experience, prolongation of the operative time, as well as a major risk in case a reintervention for valve replacement is needed. In echocardiographic terms, it translates into a larger orifice and a smaller transvalvular gradient, eliminating the risk of valve stenosis and patient-prosthesis mismatch, in clinical terms, leading to a better quality of life and an upper functional class of heart failure [4]. A stentless valve maintains the dynamic interaction between the elements of the valvular apparatus: the valvular annulus leaflets, Valsalva sinuses and the sino-tubular junction This synergic motion will lead to a better hemodynamic performance. "Root inclusion" and "full root technique" (Bentall procedure) involve re-implantation of the coronary arteries [7]

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