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Transcatheter Aortic Root Replacement With Coronary Chimney Grafts: Preliminary Results In An In-vitro Model.
Enrico Ferrari, Mira Puthettu, Stefanos Demertzis, Ludwig von Segesser.
Cardiocentro Ticino Institute, LUGANO, Switzerland.

OBJECTIVE: Transcatheter aortic root replacement (TARR) can be an option for high-risk patients in a near future. However, important concerns exist about coronary perfusion strategies and aortic valve management. The concept of chimney grafts for the coronary perfusion is a possible step towards the development of valid TARR technologies.
METHODS: A 3D-aortic root model based on human CT-scan was placed in a pulsatile circuit with water and glycerol (similar to blood viscosity) at 37C. Tests were performed at 3 pressure levels at 80-bpm: 100/60, 120/80, 140/100-mmHg. After calibration with coronary resistances and a Sapien valve in aortic position, the custom-made TARR model is inserted in the root and coronary flows are measured at different pressure levels. Measurements were performed 3 times for 10 minutes at each pressure level without (control) and with the TARR model.
RESULTS: At aortic pressure levels of 100/60mmHg (aortic flow of 4.8L/min), the control and TARR model showed mean coronary blood flows of 0.2 and 0.17 L/min on the left, and 0.13 and 0.13 L/min on the right coronary artery, respectively. At 120/80mmHg (aortic flow of 4.5L/min), mean coronary flows were 0.24 and 0.21 L/min on the left, and 0.15 and 0.15 L/min on the right coronary artery, respectively. At 140/100mmHg of pressure (aortic flow of 4.1L/min), mean flows were 0.27 and 0.25 L/min on the left, and 0.17 and 0.17 L/min on the right coronary artery, respectively. The TARR model did not displaced during the tests showing a good sealing of the main aortic endoprosthesis.
CONCLUSIONS:
This preliminary report shows that the TARR technique guarantees an adequate coronary flow in a 3D-model with dilated aortic root and using chimney endografts for coronary perfusion.


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