The Gelweave Valsalva Graft to Better Reconstruct the Anatomy of the Aortic Root.

J Long Term Eff Med Implants

Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada.

Published: March 2018


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Article Abstract

The Bentall procedure introduced in 1968 represents an undisputed cure to treat multiple pathologies involving the aortic valve and the ascending thoracic aorta. Over the years, multiple modifications have been introduced as well as a standardized approach to the operation with the goal to prevent long-term adverse events. The Gelweave Valsalva graft provides a novel manner to more efficiently reconstruct the anatomy of the aortic root either with a valve-sparing procedure or with the implantation of a valved conduit (bioprosthesis or mechanical valve). The prosthesis holds three sections: the collar anchoring the valve; the skirt mimicking the Valsalva, which is suitable for the anastomoses with the coronary arteries; and the main body of the graft, which is designed to replace the ascending aorta. The Gelweave Valsalva graft allows the Bentall operation to be standardized, and it provides a potential for longer durability with reduced adverse events.

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http://dx.doi.org/10.1615/JLongTermEffMedImplants.2016011509DOI Listing

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Article Synopsis
  • A complex surgical case of an unruptured Sinus of Valsalva aneurysm (SoVA) accompanied by severe aortic regurgitation due to cusp prolapse is discussed.
  • The surgical procedure involved reconstructing the sinus using a patch from a Gelweave Valsalva graft.
  • To address the inadequate height of the right coronary cusp found during the operation, additional modifications were made by plicating the cusp and augmenting it with a pericardial patch, leading to successful outcomes.
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Vitamin K antagonists are the only approved oral anticoagulants for long-term prophylaxis against valve thrombosis and thromboembolism in patients with a mechanical heart valve. Despite the proven efficacy and safety of anticoagulation with the oral direct factor Xa inhibitor apixaban compared with warfarin in high-risk populations including subjects with atrial fibrillation or with venous thromboembolism, it remains unknown whether patients with a mechanical heart valve can be safely managed with apixaban. The On-X Aortic Heart Valve and On-X Ascending Aortic Prosthesis with the Vascutek Gelweave Valsalva Graft may have lower rates of valve thrombosis and thromboembolism than conventional bileaflet and tilting disc valves due its unique pyrolytic carbon composition and flared inlet design.

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