Bio-chemo-mechanics of the thoracic aorta

Iddawela, Sashini; Ravendren, Andrew; Harky, Amer

doi:10.1530/vb-20-0015

Cited by 11 publications

(5 citation statements)

References 53 publications

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“…Dacron ® vascular graft, used to replace the aortic wall in AAR do not have biomechanical properties of the native vascular tissue [6][7][8][9][10]. Compliance (increase in volume for an increased in pressure) of a vascular prosthesis is 4-time lower than the aorta, and this mismatch between graft and aorta causes flow turbulence with serious clinical issues overtime.…”

Section: Discussionmentioning

confidence: 99%

Key Factor to Prevent Aortic Root and Descending Thoracic Aorta Enlargement after Aortic Valve and Ascending Aorta Combined Surgery

D’Auria,

Santo

2023

GJCD

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Objective: aortic root enlargement (ARE) and descending thoracic aorta dilatation (DTAD) in combined aortic valve and ascending aorta replacement surgery (AV+AAR) are postoperative concerning issues. This retrospective observational analysis studies surgical factors which could determine those complications. Methods: 236 patients underwent AV+AAR. Meantime follow-up by trans-thoracic echocardiography (TTE) and computer tomography (CT) was 44.7 ± 21.2 and 38.2 ± 18.4 months respectively. In long-term follow-up, outcome variables are: ARE equal/more than 10% of the preoperative TTE data and DTAD equal more than 5% of preoperative CT measurement at the same thoracic vertebrae axial slice. Results: ARE and DTAD appear strictly related to the discrepancy between prosthetic valve and straight vascular prosthesis diameters (p = 0.024), while there is not significant difference (log-rank = 0.917) related to aortic valve surgery type (replacement or repair). Considering diameter difference (DD) between vascular and aortic valve prosthesis, patients were subsequently grouped into two sections: L5 group, in which DD was less/equal than 5 mm, and M5, in which DD was more/equal than 5 mm. ARE was found in 30.8 % of L5 patients and only in 14.7 % among M5 patients (log-rank = 0.026). We have also observed descending thoracic aorta dilatation in 34.2 % of L5 and in 12.1 % of M5 (log-rank = 0.023). Conclusions: According with our data, difference between vascular prosthesis and aortic valve prosthesis equal/more than 5 mm is a protective factor against ARE and DATD.

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Section: Discussionmentioning

confidence: 99%

Key Factor to Prevent Aortic Root and Descending Thoracic Aorta Enlargement after Aortic Valve and Ascending Aorta Combined Surgery

D’Auria,

Santo

2023

GJCD

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“… Physiology of the aortic wall and pathophysiology of an aortic aneurysm (created with BioRender.com): The aorta is composed of three layers, the tunica intima containing ECs along with fibroblasts in the subendothelial layer, the tunica media, composed of elastin interlaced with collagen, and VSMCs (lamellar units), and the tunica externa (adventitia), composed of pericytes, fibroblasts, ECs, and various progenitor cell populations, such as MSCs. Normally, there is a constant turnover of collagen and elastin fibers in the tunica media, carried out by MMPs and inhibited by TIMPs; there is also an equilibrium between synthetic (sVSMC) and contractile VSMC (cVSMC) populations [ 8 , 44 , 45 ]. Aneurysm definitions may vary according to location; thus, for the Asc TA, it is defined as a diameter (d’) exceeding 4.5 cm, while for the Desc TA, AA, as well as many visceral vessels, it is defined as an increase in diameter greater than the product of the initial vessel diameter multiplied by 1.5 (d’ > d x1.5) [ 8 ].…”

Section: Figurementioning

confidence: 99%

Promising Novel Therapies in the Treatment of Aortic and Visceral Aneurysms

Stougiannou,

Christodoulou,

Georgakarakos

et al. 2023

JCM

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Aortic and visceral aneurysms affect large arterial vessels, including the thoracic and abdominal aorta, as well as visceral arterial branches, such as the splenic, hepatic, and mesenteric arteries, respectively. Although these clinical entities have not been equally researched, it seems that they might share certain common pathophysiological changes and molecular mechanisms. The yet limited published data, with regard to newly designed, novel therapies, could serve as a nidus for the evaluation and potential implementation of such treatments in large artery aneurysms. In both animal models and clinical trials, various novel treatments have been employed in an attempt to not only reduce the complications of the already implemented modalities, through manufacturing of more durable materials, but also to regenerate or replace affected tissues themselves. Cellular populations like stem and differentiated vascular cell types, large diameter tissue-engineered vascular grafts (TEVGs), and various molecules and biological factors that might target aspects of the pathophysiological process, including cell-adhesion stabilizers, metalloproteinase inhibitors, and miRNAs, could potentially contribute significantly to the treatment of these types of aneurysms. In this narrative review, we sought to collect and present relevant evidence in the literature, in an effort to unveil promising biological therapies, possibly applicable to the treatment of aortic aneurysms, both thoracic and abdominal, as well as visceral aneurysms.

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“…6 Although management of arterial hypertension is obviously important at any age to mitigate the risk of aortic dissection, the process of aging per se leads to increasing arterial wall stiffness and accelerated atherosclerosis, possibly setting the stage for at least distal aortic dissection. 7 Unfortunately, age and vascular stiffness are unlikely to be successful targets for therapy, although intravascular tension and blood pressure are tangible targets in current therapeutic thinking by lowering both pulsatile stress and diastolic pressure mirroring constant tension on the wall. Targeting a low-normal pulsatile stress or the lowest tolerable blood pressure could be the new mantra to mitigate the risk of aortic dissection.…”

Section: Article See P 633mentioning

confidence: 99%