Aortic Biomechanics and Clinical Applications

Abstract

The aorta contributes to cardiovascular physiology and function. Understanding biomechanics in health, disease, and after aortic interventions will facilitate optimization of perioperative patient care.

Aortic Biomechanics: Comment

“…We read with interest the recent review of aortic biomechanics and their clinical applications by Gregory et al 1 The authors should be congratulated for addressing this important but often underappreciated subject. Nevertheless, we are obligated to mention that the authors did not acknowledge or discuss a series of pertinent studies conducted in chronically instrumented dogs describing the effects of anesthetics on aortic biomechanics.…”

“…These studies document that the impact of anesthetics on aortic biomechanics has been examined previously in clinically relevant animal models, contrary to the article’s assertion. 1…”

“…Nevertheless, we are obligated to mention that the authors did not acknowledge or discuss a series of pertinent studies conducted in chronically instrumented dogs describing the effects of anesthetics on aortic biomechanics. This canine model is highly relevant to the review, 1 because the cardiovascular effects of anesthetics are virtually identical in dogs and humans. We and others used aortic input impedance spectra in the frequency domain 2 that were interpreted with a three-element Windkessel model of the arterial circulation, incorporating aortic mechanical properties, 3 to quantify the effects of anesthetics on left ventricular afterload.…”

Aortic Biomechanics: Reply

“…Our omission of these previous works in our recently published review on aortic biomechanics was not meant to diminish their importance. 2 Rather, the purpose of our review was to focus on concepts related to the material properties of the aorta itself in health, disease, surgery, and anesthesia, and to propose that local aortic changes may have both physiologic and clinical ramifications through the aorta’s relationship with the heart and distal arteries.…”

The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years

“…[7][8][9] In-step with these advancements, the medical sphere has had expansive knowledge growth, with genetic and biomechanical research providing necessary, and increasingly complex nuance to the preventative medical management of aortic disease. 10,11 Siloed care pathways deter specialists from referring to specialties with overlapping skills who offer alternative treatment options for consideration. In addition, because of the overlap in expertise, patients with the same aortic condition may be referred to different specialties and be treated in a different manner based on the referral patterns and focused expertise of the specialist receiving the referral.…”