Early distal remodeling after elephant trunk repair of thoraco-abdominal aortic aneurysms

Giuseppe M Raffa, Salvatore Pasta, Giovanni Gentile, Francesco Scardulla, Bryan Wu, Giuseppe D'Ancona, Fabrizio Follis, Michele Pilato

Research output: Contribution to journalArticle

Abstract

Hemodynamic alterations occur when the elephant trunk (ET) technique is adopted to treat extensive aortic aneurysms. In planning the 2nd stage operation to complete ET repair, surgeons must weigh an adequate recovery time after initial surgery against the risk of postoperative ET-related complications. The purpose of this study was to understand the mechanistic link between the flow alteration caused by the ET graft and the development of premature aortic rupture before the 2nd stage operation. Specifically, fluid-structure interaction (FSI) analysis was performed using the CT imaging data of aorta at different stages of ET repair, and then computational variables were compared to those observed in patients who underwent a prophylactic 2nd stage operation to complete aortic repair. Results show that intramural stress exerted near the distal ET anastomosis (IMS=37.5kPa) at the time of urgent intervention was comparable to that of the extensive aortic aneurysm (IMS=47.4kPa) at initial in-hospital admission, but was considerably higher than that occurring after the 1st stage procedure (IMS=3.5kPa). Pressure index suggested higher peri-graft pressurization than aortic lumen pressure during diastole, imparting an apparent risk of aortic dilatation. These critical hemodynamic and structural parameters are related to the impending rupture of descending aorta observed clinically and can thus guide prophylactic intervention and optimal timing for the 2nd stage operation of a ET technique.

Original languageEnglish
Pages (from-to)2398-404
Number of pages7
JournalJournal of Biomechanics
Volume49
Issue number12
DOIs
Publication statusPublished - Aug 16 2016

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Aortic Aneurysm
Abdominal Aortic Aneurysm
Repair
Hemodynamics
Transplants
Grafts
Aortic Rupture
Diastole
Thoracic Aorta
Aorta
Rupture
Dilatation
Arterial Pressure
Pressurization
Fluid structure interaction
Pressure
Surgery
Imaging techniques
Planning
Recovery

Keywords

  • Journal Article

Cite this

Early distal remodeling after elephant trunk repair of thoraco-abdominal aortic aneurysms. / Raffa, Giuseppe M; Pasta, Salvatore; Gentile, Giovanni; Scardulla, Francesco; Wu, Bryan; D'Ancona, Giuseppe; Follis, Fabrizio; Pilato, Michele.

In: Journal of Biomechanics, Vol. 49, No. 12, 16.08.2016, p. 2398-404.

Research output: Contribution to journalArticle

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AU - Gentile, Giovanni

AU - Scardulla, Francesco

AU - Wu, Bryan

AU - D'Ancona, Giuseppe

AU - Follis, Fabrizio

AU - Pilato, Michele

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N2 - Hemodynamic alterations occur when the elephant trunk (ET) technique is adopted to treat extensive aortic aneurysms. In planning the 2nd stage operation to complete ET repair, surgeons must weigh an adequate recovery time after initial surgery against the risk of postoperative ET-related complications. The purpose of this study was to understand the mechanistic link between the flow alteration caused by the ET graft and the development of premature aortic rupture before the 2nd stage operation. Specifically, fluid-structure interaction (FSI) analysis was performed using the CT imaging data of aorta at different stages of ET repair, and then computational variables were compared to those observed in patients who underwent a prophylactic 2nd stage operation to complete aortic repair. Results show that intramural stress exerted near the distal ET anastomosis (IMS=37.5kPa) at the time of urgent intervention was comparable to that of the extensive aortic aneurysm (IMS=47.4kPa) at initial in-hospital admission, but was considerably higher than that occurring after the 1st stage procedure (IMS=3.5kPa). Pressure index suggested higher peri-graft pressurization than aortic lumen pressure during diastole, imparting an apparent risk of aortic dilatation. These critical hemodynamic and structural parameters are related to the impending rupture of descending aorta observed clinically and can thus guide prophylactic intervention and optimal timing for the 2nd stage operation of a ET technique.

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