Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model

Foeke J.H. Nauta, Hector W.L. de Beaufort, Michele Conti, Stefania Marconi, Arnoud V. Kamman, Anna Ferrara, Joost A. van Herwaarden, Frans L. Moll, Ferdinando Auricchio, Santi Trimarchi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To quantify the impact of thoracic endovascular aortic repair (TEVAR) on radial aortic strain with the aim of elucidating stent-graft-induced stiffening and complications. METHODS: Twenty fresh thoracic porcine aortas were connected to a mock circulatory loop driven by a centrifugal flow pump. A highdefinition camera captured diameters at five different pressure levels (100, 120, 140, 160, and 180 mmHg), before and after TEVAR. Three oversizing groups were created: 0-9% (n = 7), 10-19% (n = 6), and 20-29% (n = 6). Radial strain (or deformation) derived from diameter amplitude divided by baseline diameter at 100 mmHg. Uniaxial tensile testing evaluated Young's moduli of the specimens. RESULTS: Radial strain was reduced after TEVAR within the stented segment by 49.4 ± 24.0% (P < 0.001). As result, a strain mismatch was observed between the stented segment and the proximal non-stented segment (7.0 ± 2.5% vs 11.8 ± 3.9%, P < 0.001), whereas the distal non-stented segment was unaffected (P = 0.99). Stent-graft oversizing did not significantly affect the amount of strain reduction (P = 0.30). Tensile testing showed that the thoracic aortas tended to be more elastic proximally than distally (P = 0.11). CONCLUSIONS: TEVAR stiffened the thoracic aorta by 2-fold. Such segmental stiffening may diminish the Windkessel function considerably and might be associated with TEVAR-related complications, including stent-graft-induced dissection and aneurysmal dilatation. These data may have implications for future stent-graft design, in particular for TEVAR of the highly compliant proximal thoracic aorta.

Original languageEnglish
Article numberezw369
Pages (from-to)783-789
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume51
Issue number4
DOIs
Publication statusPublished - Apr 1 2017

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Swine
Thorax
Thoracic Aorta
Stents
Transplants
Elastic Modulus
Dissection
Dilatation
Pressure

Keywords

  • Aortic strain
  • Stent-graft
  • TEVAR
  • Thoracic aorta
  • Uniaxial tensile testing

ASJC Scopus subject areas

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

Cite this

Nauta, F. J. H., de Beaufort, H. W. L., Conti, M., Marconi, S., Kamman, A. V., Ferrara, A., ... Trimarchi, S. (2017). Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model. European Journal of Cardio-thoracic Surgery, 51(4), 783-789. [ezw369]. https://doi.org/10.1093/ejcts/ezw393

Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model. / Nauta, Foeke J.H.; de Beaufort, Hector W.L.; Conti, Michele; Marconi, Stefania; Kamman, Arnoud V.; Ferrara, Anna; van Herwaarden, Joost A.; Moll, Frans L.; Auricchio, Ferdinando; Trimarchi, Santi.

In: European Journal of Cardio-thoracic Surgery, Vol. 51, No. 4, ezw369, 01.04.2017, p. 783-789.

Research output: Contribution to journalArticle

Nauta, FJH, de Beaufort, HWL, Conti, M, Marconi, S, Kamman, AV, Ferrara, A, van Herwaarden, JA, Moll, FL, Auricchio, F & Trimarchi, S 2017, 'Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model', European Journal of Cardio-thoracic Surgery, vol. 51, no. 4, ezw369, pp. 783-789. https://doi.org/10.1093/ejcts/ezw393
Nauta FJH, de Beaufort HWL, Conti M, Marconi S, Kamman AV, Ferrara A et al. Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model. European Journal of Cardio-thoracic Surgery. 2017 Apr 1;51(4):783-789. ezw369. https://doi.org/10.1093/ejcts/ezw393
Nauta, Foeke J.H. ; de Beaufort, Hector W.L. ; Conti, Michele ; Marconi, Stefania ; Kamman, Arnoud V. ; Ferrara, Anna ; van Herwaarden, Joost A. ; Moll, Frans L. ; Auricchio, Ferdinando ; Trimarchi, Santi. / Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model. In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 51, No. 4. pp. 783-789.
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abstract = "OBJECTIVES: To quantify the impact of thoracic endovascular aortic repair (TEVAR) on radial aortic strain with the aim of elucidating stent-graft-induced stiffening and complications. METHODS: Twenty fresh thoracic porcine aortas were connected to a mock circulatory loop driven by a centrifugal flow pump. A highdefinition camera captured diameters at five different pressure levels (100, 120, 140, 160, and 180 mmHg), before and after TEVAR. Three oversizing groups were created: 0-9{\%} (n = 7), 10-19{\%} (n = 6), and 20-29{\%} (n = 6). Radial strain (or deformation) derived from diameter amplitude divided by baseline diameter at 100 mmHg. Uniaxial tensile testing evaluated Young's moduli of the specimens. RESULTS: Radial strain was reduced after TEVAR within the stented segment by 49.4 ± 24.0{\%} (P < 0.001). As result, a strain mismatch was observed between the stented segment and the proximal non-stented segment (7.0 ± 2.5{\%} vs 11.8 ± 3.9{\%}, P < 0.001), whereas the distal non-stented segment was unaffected (P = 0.99). Stent-graft oversizing did not significantly affect the amount of strain reduction (P = 0.30). Tensile testing showed that the thoracic aortas tended to be more elastic proximally than distally (P = 0.11). CONCLUSIONS: TEVAR stiffened the thoracic aorta by 2-fold. Such segmental stiffening may diminish the Windkessel function considerably and might be associated with TEVAR-related complications, including stent-graft-induced dissection and aneurysmal dilatation. These data may have implications for future stent-graft design, in particular for TEVAR of the highly compliant proximal thoracic aorta.",
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AU - de Beaufort, Hector W.L.

AU - Conti, Michele

AU - Marconi, Stefania

AU - Kamman, Arnoud V.

AU - Ferrara, Anna

AU - van Herwaarden, Joost A.

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N2 - OBJECTIVES: To quantify the impact of thoracic endovascular aortic repair (TEVAR) on radial aortic strain with the aim of elucidating stent-graft-induced stiffening and complications. METHODS: Twenty fresh thoracic porcine aortas were connected to a mock circulatory loop driven by a centrifugal flow pump. A highdefinition camera captured diameters at five different pressure levels (100, 120, 140, 160, and 180 mmHg), before and after TEVAR. Three oversizing groups were created: 0-9% (n = 7), 10-19% (n = 6), and 20-29% (n = 6). Radial strain (or deformation) derived from diameter amplitude divided by baseline diameter at 100 mmHg. Uniaxial tensile testing evaluated Young's moduli of the specimens. RESULTS: Radial strain was reduced after TEVAR within the stented segment by 49.4 ± 24.0% (P < 0.001). As result, a strain mismatch was observed between the stented segment and the proximal non-stented segment (7.0 ± 2.5% vs 11.8 ± 3.9%, P < 0.001), whereas the distal non-stented segment was unaffected (P = 0.99). Stent-graft oversizing did not significantly affect the amount of strain reduction (P = 0.30). Tensile testing showed that the thoracic aortas tended to be more elastic proximally than distally (P = 0.11). CONCLUSIONS: TEVAR stiffened the thoracic aorta by 2-fold. Such segmental stiffening may diminish the Windkessel function considerably and might be associated with TEVAR-related complications, including stent-graft-induced dissection and aneurysmal dilatation. These data may have implications for future stent-graft design, in particular for TEVAR of the highly compliant proximal thoracic aorta.

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