Leaflet Kinematics After The Yacoub And Florida-Sleeve Operations: Results Of An In Vitro Study

OBJECTIVES: The Florida-sleeve is a valve-sparing technique that causes minimal interference to leaflet kinematics and aortic root dynamism. The aim of this in vitro study was to evaluate the effects of the Florida-sleeve and Yacoub techniques on aortic leaflet kinematics.METHODS: Two groups of 6 whole porcine hearts were treated with either the Florida-sleeve technique or the Yacoub technique and tested in a pulsatile loop. Valve fluid dynamics, coronary flow analysis and valve echocardiograms were performed both before and after the procedures.RESULTS: Both procedures showed no difference in rapid valve opening time as compared with their respective baseline values. The Florida-sleeve procedure showed a shorter slow closing time (19219ms vs baseline 24414ms, P=0.016) and increased slow closing velocity (-1.5 +/- 0.4cm/s vs baseline -0.8 +/- 0.4cm/s, P=0.038). In the rapid valve closing phase, the Yacoub procedure showed a trend towards slower closing valve velocity (-16 +/- 9cm/s vs baseline -25 +/- 9cm/s, P=0.07). The Yacoub procedure showed larger leaflet displacement at the end of the slow valve closing time that was 2.0 +/- 0.5cm vs baseline 1.5 +/- 0.3cm, P=0.044. When comparing the Florida-sleeve and Yacoub procedures, the former showed statistically significant shorter slow valve closing time (P=0.017).CONCLUSIONS: This study showed that the Florida-sleeve technique alters the slow closing phase of the aortic valve leaflet kinematics when compared with both the normal baseline and Yacoub procedure, while the latter showed a larger leaflet displacement before the rapid closing valve phase.