The RA provides the same clinical and angiographic results both as aorto-coronary and composite Y-graft with the left ITA. When the RA is used as Y-graft the procedure is more technically demanding and a greater number of distal coronary anastomoses is possible. RA grafts to targets with stenosis < or = 70% appear to be at risk of failure.

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This experimental work demonstrated that the transcatheter edge-to-edge repair technique is a feasible approach for FTR. The study investigated this approach to develop a selective, specific structural intervention methodology for treating FTR, considering the several biomechanical factors that alter proper functionality of valvular substructures. These results can be used to guide the development of edge-to-edge repair techniques in treatment of FTR.

The aortic root functional unit (ARFU) is a complex structure whose functions are strictly dependent on the biomechanical interaction among each of its anatomically defined elements. The classical approach to the in vitro study of aortic hydrodynamics does not take this complexity into account. We propose a novel methodology based on the possibility to house whole natural ARFU samples in a purposely designed pulsatile mock loop, allowing for aortic surgery simulation. To point out the usability and potentialities of the device, the mock loop was tested with untreated porcine ARFU samples and with one ARFU prosthesized with a state-of-the-art bioprosthesis. The sample holder design was proved to allow the clinician to house and treat the ARFU sample in the mock loop with easiness and repeatability. The valve leakage with the prosthesized ARFU was comparable with literature data, and Effective orifice areas were consistent with the constructor's data. In contrast, the recorded pressure drops exceeded the data from the manufacturer and were quite aligned with in vivo postop echo-Doppler data acquired in implant recipients. This result suggests that our apparatus and methodology provide a way to investigate aortic hydrodynamic phenomena that resemble in a close way to those taking place in the final recipients' circulation.

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