Systematic adjustment of root dimensions to cusp size in aortic valve repair: a computer simulation

Gil Marom, Luca Paolo Weltert, Ehud Raanani, Ilaria Chirirchilli, Christian Giebels, Francesco Giosué Irace, Ruggero De Paulis, Hans Joachim Sch€afers

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Aortic valve repair requires the creation of a normal geometry of cusps and aortic root. Of the different dimensions, geometric cusp height is the most difficult to change while annular and sinotubular dimensions can be easily modified. The objective of this study was to investigate, by computer simulation, ideal combinations of annular and sinotubular junction size for a given geometric height. METHODS: Based on a literature review of anatomical data, a computational biomechanics model was generated for a tricuspid aortic valve. We aimed to determine the ideal relationships for the root dimensions, keeping geometric height constant and creating different combinations of the annular and sinotubular junction dimensions. Using this model, 125 virtual anatomies were created, with 25 different combinations of annulus and sinotubular junction. Effective height, coaptation height and mechanical cusp stress were calculated with the valves in closed configuration. RESULTS: Generally, within the analysed range of geometric heights, changes to the annular diameter yielded a stronger impact than sinotubular junction diameter changes for optimal valve configuration. The best results were obtained with the sinotubular junction being 2-4mm larger than the annulus, leading to higher effective height, normal coaptation height and lower stress. Within the range tested, stenosis did not occur due to annular reduction. CONCLUSIONS: In tricuspid aortic valves, the geometric height can be used to predict ideal post-repair annular and sinotubular junction dimensions for optimal valve configuration. Such an ideal configuration is associated with reduced cusp stress.

Original languageEnglish
Article numberivae024
JournalInterdisciplinary cardiovascular and thoracic surgery
Issue number2
StatePublished - 1 Feb 2024


  • Aortic valve repair
  • Coaptation height
  • Effective height
  • Geometric height
  • Numerical model

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery


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