Improved Hemodynamic Performance with a 3-Dimensional Reinforced Ringed-Graft for Valve-Sparing Aortic Root Replacement in Bicuspid Aortic Valve
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0135
Submission Type:
Abstract Submission
Authors:
Masafumi Shibata (1), Perry Choi (2), Amit Sharir (3), Chris Huynh (4), Riya Nilkant (5), Matthew Park (6), Sarah Chen (7), Michael Ma (8), Y. Joseph Woo (3), Joon Bum Kim (9)
Institutions:
(1) Stanford University, Sunnyvale, CA, (2) Stanford University, Palo Alto, CA, (3) Stanford University, Stanford, CA, (4) Stanford University School of Medicine, Campbell, CA, (5) Stanford University School of Medicine, CA, (6) Stanford University School of Medicine, Palo Alto, CA, (7) University of Michigan, Ann Arbor, MI, (8) Stanford University School of Medicine, Stanford, CA, (9) Asan Medical Center, Seoul, NA
Submitting Author:
Masafumi Shibata
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Stanford University
Stanford University
Co-Author(s):
Perry Choi
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Stanford University
Stanford University
Amit Sharir
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Stanford University
Stanford University
Chris Huynh
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Stanford University School of Medicine
Stanford University School of Medicine
Riya Nilkant
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Stanford University School of Medicine
Stanford University School of Medicine
Matthew Park
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Stanford University School of Medicine
Stanford University School of Medicine
Sarah Chen
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University of Michigan
University of Michigan
*Michael Ma
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Stanford University School of Medicine
Stanford University School of Medicine
*Joseph Woo
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Stanford University
Stanford University
*Joon Bum Kim
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Asan Medical Center
Asan Medical Center
Presenting Author:
Masafumi Shibata
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Stanford University
Stanford University
Abstract:
Objective: Valve-sparing aortic root replacement (VSARR) provides durable outcomes in bicuspid aortic valve (BAV) disease but is technically demanding and performed only by highly experienced surgeons due to procedural complexity and difficulty in achieving uniform root geometry. To address these limitations, we developed a novel three-dimensional (3D) reinforced ringed-graft designed to restore root geometry in a standardized configuration with rigid annular support. This study compared its hemodynamic performance with the conventional David reimplantation technique.
Methods: A semi-rigid 3D-printed photopolymer frame (A) replicating the valvulo-aortic junction was integrated into a 28-mm woven polyester graft (B). Five porcine hearts were studied in a validated ex-vivo left heart simulator after creation of a BAV model by fusing two cusps to form a pseudo-raphe. For the novel procedure, multiple mattress sutures were placed around the trimmed aortic root (C), passed through the device, and tied to seat it onto the root, requiring only a single-layer suture line (D). Each root underwent both the novel VSARR and David reimplantation in randomized order to equalize baseline conditions. Hemodynamic performance - including aortic regurgitation (AR), effective orifice area (EOA), transvalvar pressure gradient, and leaflet kinematics - was analyzed by left-heart simulator and with high-speed leaflet tracking.
Results: The novel VSARR demonstrated significantly lower AR fraction (7.8 ± 2.9% vs 18.5 ± 7.3%, p = 0.03, E), larger EOA (1.47 ± 0.19 cm² vs 1.19 ± 0.21 cm², p = 0.03, F) and a trend toward lower transvalvar pressure gradient (5.1 ± 1.4 mmHg vs 8.6 ± 2.3 mmHg, p = 0.16, G) compared with conventional reimplantation. Leaflet opening, closing, and acceleration dynamics were comparable between groups.
Conclusions: In an ex-vivo BAV model, VSARR using the novel 3D reinforced ringed-graft achieved superior hemodynamic outcomes with lower AR fraction and larger EOA compared with the conventional reimplantation technique. By enabling seating of the graft with a simplified single-layer suture line, this device may streamline VSARR, enhance reproducibility beyond only the most experienced surgeons. Further in vivo and clinical studies are warranted.
Methods: A semi-rigid 3D-printed photopolymer frame (A) replicating the valvulo-aortic junction was integrated into a 28-mm woven polyester graft (B). Five porcine hearts were studied in a validated ex-vivo left heart simulator after creation of a BAV model by fusing two cusps to form a pseudo-raphe. For the novel procedure, multiple mattress sutures were placed around the trimmed aortic root (C), passed through the device, and tied to seat it onto the root, requiring only a single-layer suture line (D). Each root underwent both the novel VSARR and David reimplantation in randomized order to equalize baseline conditions. Hemodynamic performance - including aortic regurgitation (AR), effective orifice area (EOA), transvalvar pressure gradient, and leaflet kinematics - was analyzed by left-heart simulator and with high-speed leaflet tracking.
Results: The novel VSARR demonstrated significantly lower AR fraction (7.8 ± 2.9% vs 18.5 ± 7.3%, p = 0.03, E), larger EOA (1.47 ± 0.19 cm² vs 1.19 ± 0.21 cm², p = 0.03, F) and a trend toward lower transvalvar pressure gradient (5.1 ± 1.4 mmHg vs 8.6 ± 2.3 mmHg, p = 0.16, G) compared with conventional reimplantation. Leaflet opening, closing, and acceleration dynamics were comparable between groups.
Conclusions: In an ex-vivo BAV model, VSARR using the novel 3D reinforced ringed-graft achieved superior hemodynamic outcomes with lower AR fraction and larger EOA compared with the conventional reimplantation technique. By enabling seating of the graft with a simplified single-layer suture line, this device may streamline VSARR, enhance reproducibility beyond only the most experienced surgeons. Further in vivo and clinical studies are warranted.
ADULT CARDIAC:
Aortic Valve
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