{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:38:38Z","timestamp":1791632318742,"version":"4.3.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Valve-sparing procedures are surgical techniques allowing to restore adequate function of the native aortic valve by replacing the dysfunctional ascending aorta with a prosthetic conduit. A number of techniques are currently used, such as Yacoub\u2019s remodelling and David\u2019s reimplantation, based on a regular straight conduit. More recently, the De Paulis proposed the use of bulging conduits to reconstruct the shape of the Valsalva sinuses. This work investigates the impact of the valve-sparing technique on the aortic valve function.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The performance of 3 porcine aortic roots (Medtronic Freestyle\u2122) was assessed in a cardiovascular pulse duplicator before and after performing 3 alternative valve-sparing procedures: David\u2019s reimplantation, Yacoub\u2019s remodelling and De Paulis\u2019 reimplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The porcine aortic roots, representative of the healthy native configuration, were characterized by the highest efficiency, with a mean energetic dissipation under normal operating conditions of 26\u2009mJ. David\u2019s and Yacoub\u2019s techniques resulted in significantly lower performance (with mean energetic loss of about 70\u2009mJ for both cases). The De Paulis\u2019 procedure exhibited intermediate behaviour, with superior systolic performance and valve dynamics similar to the native case, and a mean energetic loss of 38\u2009mJ.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The dynamics and performance after valve-sparing strongly depend on the adopted technique, with the use of conduits replicating the presence of Valsalva sinuses restoring more physiological conditions.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezad040","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T15:43:56Z","timestamp":1675698236000},"source":"Crossref","is-referenced-by-count":6,"title":["Hydrodynamic<i>ex vivo<\/i>analysis of valve-sparing techniques: assessment and comparison"],"prefix":"10.1093","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-1396","authenticated-orcid":false,"given":"Sofia","family":"Di Leonardo","sequence":"first","affiliation":[{"name":"Bioengineering Group, Ri.MED Foundation , Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6251-3651","authenticated-orcid":false,"given":"Danila","family":"Vella","sequence":"additional","affiliation":[{"name":"Bioengineering Group, Ri.MED Foundation , Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo Savio","family":"Grillo","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Palermo , Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Martorana","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Palermo , Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0711-1067","authenticated-orcid":false,"given":"Salvatore","family":"Torre","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Palermo , Palermo, Italy"},{"name":"Cardiac Surgery Unit, Policlinico Paolo Giaccone, University of Palermo , Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Argano","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Palermo , Palermo, Italy"},{"name":"Cardiac Surgery Unit, Policlinico Paolo Giaccone, University of Palermo , Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9213-3403","authenticated-orcid":false,"given":"Gaetano","family":"Burriesci","sequence":"additional","affiliation":[{"name":"Bioengineering Group, Ri.MED Foundation , Palermo, Italy"},{"name":"UCL Mechanical Engineering, University College London , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,6]]},"reference":[{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/ejcts\/ezr093","article-title":"The everyday used nomenclature of the aortic root components: the tower of Babel?","volume":"41","author":"Sievers","year":"2012","journal-title":"Eur J Cardio-Thoracic Surg"},{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1177\/1358863X18807760","article-title":"Thoracic aortic aneurysm","volume":"23","author":"Salameh","year":"2018","journal-title":"Vasc Med"},{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jacc.2016.04.062","article-title":"Aortic valve sparing in different aortic valve and aortic root conditions","volume":"68","author":"David","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/S0022-5223(19)34942-6","article-title":"An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta","volume":"103","author":"David","year":"1992","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0022-5223(19)34225-4","article-title":"Remodeling of the aortic valve anulus","volume":"105","author":"Sarsam","year":"1993","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/icvts\/ivaa290","article-title":"In patients undergoing valve-sparing aortic root replacement, is reimplantation superior to remodelling?","volume":"32","author":"Maskell","year":"2021","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2023040315513574000_","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11748-017-0833-6","article-title":"Valve-sparing aortic root surgery. 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