Ascending Aortic Endograft and Thoracic Aortic Deformation After Ascending Thoracic Endovascular Aortic Repair
Artikel i vetenskaplig tidskrift, 2023

Purpose: We aim to quantify multiaxial cardiac pulsatility-induced deformation of the thoracic aorta after ascending thoracic endovascular aortic repair (TEVAR) as a part of the GORE ARISE Early Feasibility Study. Materials and Methods: Fifteen patients (7 females and 8 males, age 73±9 years) with ascending TEVAR underwent computed tomography angiography with retrospective cardiac gating. Geometric modeling of the thoracic aorta was performed; geometric features including axial length, effective diameter, and centerline, inner surface, and outer surface curvatures were quantified for systole and diastole; and pulsatile deformations were calculated for the ascending aorta, arch, and descending aorta. Results: From diastole to systole, the ascending endograft exhibited straightening of the centerline (0.224±0.039 to 0.217±0.039 cm−1, p<0.05) and outer surface (0.181±0.028 to 0.177±0.029 cm−1, p<0.05) curvatures. No significant changes were observed for inner surface curvature, diameter, or axial length in the ascending endograft. The aortic arch did not exhibit any significant deformation in axial length, diameter, or curvature. The descending aorta exhibited small but significant expansion of effective diameter from 2.59±0.46 to 2.63±0.44 cm (p<0.05). Conclusion: Compared with the native ascending aorta (from prior literature), ascending TEVAR damps axial and bending pulsatile deformations of the ascending aorta similar to how descending TEVAR damps descending aortic deformations, while diametric deformations are damped to a greater extent. Downstream diametric and bending pulsatility of the native descending aorta was muted compared with that in patients without ascending TEVAR (from prior literature). Deformation data from this study can be used to evaluate the mechanical durability of ascending aortic devices and inform physicians about the downstream effects of ascending TEVAR to help predict remodeling and guide future interventional strategies. Clinical Impact: This study quantified local deformations of both stented ascending and native descending aortas to reveal the biomechanical impact of ascending TEVAR on the entire thoracic aorta, and reported that the ascending TEVAR muted cardiac-induced deformation of the stented ascending aorta and native descending aorta. Understanding of in vivo deformations of the stented ascending aorta, aortic arch and descending aorta can inform physicians about the downstream effects of ascending TEVAR. Notable reduction of compliance may lead to cardiac remodeling and long-term systemic complications. This is the first report which included dedicated deformation data regarding ascending aortic endograft from clinical trial.

ascending aorta

deformation

descending thoracic aorta

thoracic endovascular aortic repair (TEVAR)

endovascular therapy

Författare

Ga Young Suh

Stanford University

The California State University

Johan Bondesson

Chalmers, Mekanik och maritima vetenskaper, Dynamik

Yufei D. Zhu

University of California

Michael C. Nilson

W. L. Gore and Associates Inc., USA

Eric E. Roselli

Cleveland Clinic Foundation

Christopher Cheng

Stanford University

Journal of Endovascular Therapy

1526-6028 (ISSN) 1545-1550 (eISSN)

Vol. In Press

Ämneskategorier

Kirurgi

Kardiologi

Radiologi och bildbehandling

DOI

10.1177/15266028231168351

PubMed

37144300

Mer information

Senast uppdaterat

2023-05-31