Commentary: Preventing pulmonary autograft dilatation: Many unanswered questions

Central MessageInclusion of the pulmonary autograft inside a polyethylene terephthalate graft prevents late dilatation, but adversely changes biomechanical properties that may limit long-term durability.See Article page e103. Inclusion durability. See A normal aortic root has complex anatomy, and its components move in dynamic fashion with coordinated shape size during cardiac cycle allows for hemodynamic parameters optimal valve function lifetime.1Yacoub M.H. Kilner P.J. Birks E.J. Misfeld M. The outflow root: tale dynamism crosstalk.Ann Thorac Surg. 1999; 68: S37-S43Abstract Full Text PDF PubMed Google Scholar None currently available substitutes can entirely reproduce these sophisticated functions. Although (PA) is living structure capable adaptative remodeling when transposed to systemic circulation, it specific morphometric features influence durability.2Azadani A.N. Chitsaz S. Matthews P.B. Jaussaud N. Leung J. Wisneski A. et al.Biomechanical comparison human roots.Eur J Cardiothorac 2012; 41: 1111-1116Crossref Scopus (45) leaflets have similar properties, wall artery thinner fewer elastic fibers, making stiffer less compliant submitted pressures, predisposing progressive dilatation.2Azadani Scholar,3Chauvette V. Chamberland M.E. El-Hamamsy I. review external support Ross procedure.Expert Rev Med Devices. 2019; 16: 981-988Crossref (12) Aortic replacement PA be accomplished different techniques, each advantages drawbacks.4Aboud Charitos E.I. Fujita B. Stierle U. Reil J.C. Voth al.Long-term outcomes patients undergoing procedure.J Am Coll Cardiol. 2021; 77: 1412-1422Crossref Long-term follow-up data demonstrated that, despite differences modes failure, freedom from dysfunction and/or need reoperations relatively independent technique implantation.4Aboud Scholar,5David T.E. Ouzounian David C.M. Lafreniere-Roula Manlhiot C. Late results Cardiovasc 157: 201-208Abstract (72) became most frequently used possibly because transposing as single unit easiest reproducible way obtain competent no or minimal geometrical distortion.5David main concern vulnerability dilatation without incompetence, reported incidence varying 69% 93% at 15 years.5David Scholar,6Klieverik L.M. Takkenberg J.J. Bekkers J.A. Roos-Hesselink J.W. Witsenburg Bogers A.J. operation: Trojan horse?.Eur Heart 2007; 28: 1993-2000Crossref (99) To avoid some advocated reinforcement grafts, polytetrafluoroethylene, bovine pericardium.3Chauvette insertion rigid synthetic distort geometry, restricting sinus expansion distensibility, which leaflet opening-and-closing mechanism, coronary flow reserve, left ventricular impedance.3Chauvette Zhu colleagues7Zhu Y. Marin-Cuartas Park Imbrie-Moore A.M. Wilkerson R.J. Madira al.Ex vivo analysis procedure using modified inclusion 3D-printed heart simulator.J 2023; 165: e103-e116Abstract (3) demonstrate, an experimental model, placing was associated markedly increased velocities opening closing leaflets, finding already been observed after valve-sparing replacement. addition anticommissural plication stitches able partially minimize abnormalities, still not unsupported controls. Excessive cusp fluttering clearly detected both supported groups. In addition, authors demonstrate coaptation surface degree redundancy diastole.7Zhu this helpful achieving valve, one might argue slight excess tissue fact detrimental due bending stresses impair Until are polyethylene-terephthalate–reinforced PA, I favor, selected cases, autologous aorta, effective preventing 96% reoperation 18 years.8Skillington P.D. Mokhles M.M. Larobina O'Keefe Wynne R. al.The autograft: techniques results.J 2015; 149: S46-S52Abstract (92) recognized model limitations, they should encouraged further extend their investigations, including fatigue testing various versions reinforced PA. Further laboratory studies coupled animal investigations will eventually only clarify merits technique, also help refining aspects such sizing configurations use alternative materials resorbable meshes.9Nappi F. Spadaccio Fraldi Montagnani Fouret P. Chachques al.A composite semiresorbable armoured scaffold stabilizes Mr Ross's dream fulfilled.J 2016; 151: 155-164.e1Abstract (34) Ex 3-dimensionally printed simulatorThe Journal Thoracic Cardiovascular SurgeryVol. 165Issue 3PreviewThe developed reinforce prevent dilation procedure. Anticommissural (ACP), modification reduce create neosinuses. objective evaluate biomechanics ACP. Full-Text