Changes in Coronary Flow Reserve following Stent Implantation in the Swine Descending Thoracic Aorta

Zacharoulis, Achilles A.; Arapi, Sophia; Lazaros, George; Karavidas, Apostolos; Zacharoulis, Achilleas

doi:10.1177/152660280701400417

Cited by 13 publications

(5 citation statements)

References 30 publications

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“…Aortic stiffening is known to play a significant role in cardiovascular disease development and progression [8,9]. Several preclinical studies have reported on acute stiffening of the aorta following TEVAR, resulting in acute elevated pulse pressure, hypertension, reduced coronary perfusion and eventually heart failure [10,11]. These findings have been confirmed by computational studies using simplified blood flow models [12].…”

Section: Introductionmentioning

confidence: 89%

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Bakel

Arthurs

Nauta

et al. 2018

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Current endografts for thoracic endovascular aortic repair (TEVAR) are much stiffer than the aorta and have been shown to induce acute stiffening. In this study, we aimed to estimate the impact of TEVAR on left ventricular (LV) stroke work (SW) and mass using a non-invasive image-based workflow. METHODS The University of Michigan database was searched for patients treated with TEVAR for descending aortic pathologies (2013–2016). Patients with available pre-TEVAR and post-TEVAR computed tomography angiography and echocardiography data were selected. LV SW was estimated via patient-specific fluid–structure interaction analyses. LV remodelling was quantified through morphological measurements using echocardiography and electrocardiographic-gated computed tomography angiography data. RESULTS Eight subjects were included in this study, the mean age of the patients was 68 (73, 25) years, and 6 patients were women. All patients were prescribed antihypertensive drugs following TEVAR. The fluid–structure interaction simulations computed a 26% increase in LV SW post-TEVAR [0.94 (0.89, 0.34) J to 1.18 (1.11, 0.65) J, P = 0.012]. Morphological measurements revealed an increase in the LV mass index post-TEVAR of +26% in echocardiography [72 (73, 17) g/m2 to 91 (87, 26) g/m2, P = 0.017] and +15% in computed tomography angiography [52 (46, 29) g/m2 to 60 (57, 22) g/m2, P = 0.043]. The post- to pre-TEVAR LV mass index ratio was positively correlated with the post- to pre-TEVAR ratios of SW and the mean blood pressure (ρ = 0.690, P = 0.058 and ρ = 0.786, P = 0.021, respectively). CONCLUSIONS TEVAR was associated with increased LV SW and mass during follow-up. Medical device manufacturers should develop more compliant devices to reduce the stiffness mismatch with the aorta. Additionally, intensive antihypertensive management is needed to control blood pressure post-TEVAR.

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Section: Introductionmentioning

confidence: 89%

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Bakel

Arthurs

Nauta

et al. 2018

European Journal of Cardio-Thoracic Surgery

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“…The aortic compliance serves a critical function to reduce the impedance and workload of cardiac ejection ( 46 ). Preclinical ( 30 , 47 – 49 ) and preliminary clinical ( 50 ) studies have reported on acute stiffening of the aorta following TEVAR, resulting in acute elevated pulse pressure, hypertension, reduced coronary perfusion, and eventually heart failure ( 47 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

An in vitro Assessment of the Haemodynamic Features Occurring Within the True and False Lumens Separated by a Dissection Flap for a Patient-Specific Type B Aortic Dissection

Morris

Tierney

Hynes

et al. 2022

Front. Cardiovasc. Med.

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One of the highest mortality rates of cardiovascular diseases is aortic dissections with challenging treatment options. Currently, less study has been conducted in developing in vitro patient-specific Type B aortic dissection models, which mimic physiological flow conditions along the true and false lumens separated by a dissection flap with multiple entry and exit tears. A patient-specific Stanford Type B aortic dissection scan was replicated by an in-house manufactured automatic injection moulding system and a novel modelling technique for creating the ascending aorta, aortic arch, and descending aorta incorporating arterial branching, the true/false lumens, and dissection flap with entry and exit intimal tears. The physiological flowrates and pressure values were monitored, which identified jet stream fluid flows entering and exiting the dissection tears. Pressure in the aorta’s true lumen region was controlled at 125/85 mmHg for systolic and diastolic values. Pressure values were obtained in eight sections along the false lumen using a pressure transducer. The true lumen systolic pressure varied from 122 to 128 mmHg along the length. Flow patterns were monitored by ultrasound along 12 sections. Detailed images obtained from the ultrasound transducer probe showed varied flow patterns with one or multiple jet steam vortices along the aorta model. The dissection flap movement was assessed at four sections of the patient-specific aorta model. The displacement values of the flap varied from 0.5 to 3 mm along the model. This model provides a unique insight into aortic dissection flow patterns and pressure distributions. This dissection phantom model can be used to assess various treatment options based on the surgical, endovascular, or hybrid techniques.

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“…Several experimental studies, in addition to clinical trials, show that stent-grafts increase the pulse wave velocity (PWV) of the aorta (de Beaufort et al 2017;Kadoglou et al 2012Kadoglou et al , 2014Liam Morris et al 2013;Van Noort et al 2018), which is an independent risk factor for cardiac failure (Ben-Shlomo et al 2014). Importantly, the Windkessel effect is diminished following stenting (Nauta et al 2017;Belz 1995), and increased PWV has been directly linked to cardiac death via a complex cascade of increased pulse pressure (Benetos et al 1997), increased left-ventricular afterload and decreased coronary flow (Spadaccio et al 2016;Zacharoulis et al 2007), and ultimately left ventricular hypertrophy (Kim et al 1995;Morita et al 2002).…”

Section: Discussion and Concluding Remarksmentioning

confidence: 99%

Influence of shape-memory stent grafts on local aortic compliance

Concannon

Moerman

Hynes

et al. 2021

Biomech Model Mechanobiol

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The effect of repair techniques on the biomechanics of the aorta is poorly understood, resulting in significant levels of postoperative complications for patients worldwide. This study presents a computational analysis of the influence of Nitinol-based devices on the biomechanical performance of a healthy patient-specific human aorta. Simulations reveal that Nitinol stent-grafts stretch the artery wall so that collagen is stretched to a straightened high-stiffness configuration. The high-compliance regime (HCR) associated with low diastolic lumen pressure is eliminated, and the artery operates in a low-compliance regime (LCR) throughout the entire cardiac cycle. The slope of the lumen pressure–area curve for the LCR post-implantation is almost identical to that of the native vessel during systole. This negligible change from the native LCR slope occurs because the stent-graft increases its diameter from the crimped configuration during deployment so that it reaches a low-stiffness unloading plateau. The effective radial stiffness of the implant along this unloading plateau is negligible compared to the stiffness of the artery wall. Provided the Nitinol device unloads sufficiently during deployment to the unloading plateau, the degree of oversizing has a negligible effect on the pressure–area response of the vessel, as each device exerts approximately the same radial force, the slope of which is negligible compared to the LCR slope of the native artery. We show that 10% oversizing based on the observed diastolic diameter in the mid descending thoracic aorta results in a complete loss of contact between the device and the wall during systole, which could lead to an endoleak and stent migration. 20% oversizing reaches the Dacron enforced area limit (DEAL) during the pulse pressure and results in an effective zero-compliance in the later portion of systole.

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Changes in Coronary Flow Reserve following Stent Implantation in the Swine Descending Thoracic Aorta

Abstract: Stent deployment in the normal swine DTA produces a significant immediate decrease in CFR, which is attenuated 3 weeks later. The clinical impact of CFR changes following DTA endografting remain to be elucidated.

Cited by 13 publications

References 30 publications

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms

An in vitro Assessment of the Haemodynamic Features Occurring Within the True and False Lumens Separated by a Dissection Flap for a Patient-Specific Type B Aortic Dissection

Influence of shape-memory stent grafts on local aortic compliance

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