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Technical Aspects of the Aortic Root Reconstruction Procedures: Assessing the impact and the reproducibility of the Coroneo Extra-Aortic Annuloplasty Ring on Homografts

R. Novotný1, J. Hlubocký1, J.Špatenka2, D.Slížová3, P.Mitáš1, J. Lindner1

1- 2nd Surgical Clinic of Cardiovascular Surgery, General Teaching Hospital, Prague & 1st Faculty of Medicine, Charles University, Prague, Czech Republic
2- Department of Transplantation and Tissue Bank, Motol Hospital, Prague, Czech Republic
3- Department of Anatomy, Faculty of Medicine in Hradec Kralove, Charles University,, Czech Republic

Aortic valve sparing operations were refined in order to preserve the native aortic valve during surgery for the aortic root aneurysm and surgery for the ascending aortic aneurysm with associated aortic insufficiency. The aortic root is an ensemble consisting of distinct entities: the aortic valve leaflets, the leaflet attachments, the sinuses of Valsava, the interleaflet trigones, the sinotubular junction and the annulus. It is a remarkably complex and sophisticated structure.

Every single constituent of the aortic root has an optimal macroscopic, microscopic structure and anatomical architecture which contributes to the function of the aortic root: intermittent, unidirectional channeling of large volumes of fluid while maintaining laminar flow, minimal resistance, the least possible tissue stress and damage during varying hemodynamic conditions and demands. This synchronized dynamic behavior of all aortic root components has shown to be of a great importance for a specific flow characteristic, left ventricle function and coronary perfusion. When any of the aortic root components fail, it is the recognition of the complexity of the structure that has led to the development and advancements in sparing surgical procedures that respect the fundamental anatomical existence of the individual parts of the aortic root.

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