Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms

Xuan, Yue; D’Souza, Sara N.; Wang, Zhongjie; Suarez‐Pierre, Alejandro; Lawton, Jennifer S.; Ge, Liang; Tseng, Elaine E.

doi:10.1016/j.athoracsur.2021.07.042

Cited by 15 publications

(14 citation statements)

References 23 publications

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“…Understanding the distribution of biomechanical wall stress in the various anatomic locations of the aorta, as well as potential contributions of hemodynamic flow disturbances such as those from aortic valve stenosis or regurgitation, or even from a well-functioning BAV, may improve risk stratification strategies and, in turn, patient outcomes, filling a knowledge gap on wall stress distribution in patients with aortic aneurysms. 1-4…”

Section: Evidence Gaps and Future Directionsmentioning

confidence: 99%

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Isselbacher¹,

Preventza²,

Black³

et al. 2022

Circulation

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410

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Aim: The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). Methods: A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.

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Section: Evidence Gaps and Future Directionsmentioning

confidence: 99%

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Isselbacher¹,

Preventza²,

Black³

et al. 2022

Circulation

Self Cite

747

410

View full text Add to dashboard Cite

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“…Second, FEA when applied to 3D echocardiography and to 3D CT scan can be used to calculate stresses and investigate potential failure modes and locations in the extracellular matrix. [18][19][20][21] ORCID Francesco Nappi https://orcid.org/0000-0002-9705-5360…”

Section: Remodeling In Cardiac Structuresmentioning

confidence: 99%

“…The more recent studies have advanced and focused on the biomechanical behavior of the cardiac and vascular structures associated with the structural and biomolecular modifications of the extracellular matrix. [17][18][19][20][21] From a biomolecular point of view, Bartko et al 17 processes, without eliminating the adaptive growth. 17 No studies to date have long-term prospective data based on biomechanical modeling through the use of finite element analysis (FEA) and evaluation of morphostructure.…”

Section: Remodeling In Cardiac Structuresmentioning

confidence: 99%

“…So, what next? The more recent studies have advanced and focused on the biomechanical behavior of the cardiac and vascular structures associated with the structural and biomolecular modifications of the extracellular matrix 17–21 …”

Section: Remodeling In Cardiac Structuresmentioning

confidence: 99%

“…This task will be first, nuanced by the fact that FEA is the primary method to acquire precious information about complex real‐world systems that would otherwise be impossible to calculate directly. Second, FEA when applied to 3D echocardiography and to 3D CT scan can be used to calculate stresses and investigate potential failure modes and locations in the extracellular matrix 18–21 …”

Section: Remodeling In Cardiac Structuresmentioning

confidence: 99%

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The role of the extracellular matrix in the development of heart valve disease: Underestimation or undercomprehension?

Nappi

2022

Journal of Cardiac Surgery

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The function of metalloproteinases of the extracellular matrix and their inhibitors has emerged with a crucial role in valve diseases. Both the expression of matrix metalloproteinases and their inhibitors are susceptible to modification in patients with severe mitral insufficiency. This process is due to substantial changes in the collagen structure during mechanical stress on the mitral valve leaflets. Several studies have

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The Influence of Material Properties and Wall Thickness on Predicted Wall Stress in Ascending Aortic Aneurysms: A Finite Element Study

Zhu,

Pirola,

Salmasi

et al. 2024

Cardiovasc Eng Tech

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Purpose Finite element analysis (FEA) has been used to predict wall stress in ascending thoracic aortic aneurysm (ATAA) in order to evaluate risk of dissection or rupture. Patient-specific FEA requires detailed information on ATAA geometry, loading conditions, material properties, and wall thickness. Unfortunately, measuring aortic wall thickness and mechanical properties non-invasively poses a significant challenge, necessitating the use of non-patient-specific data in most FE simulations. This study aimed to assess the impact of employing non-patient-specific material properties and wall thickness on ATAA wall stress predictions. Methods FE simulations were performed on 13 ATAA geometries reconstructed from computed tomography angiography (CTA) images. Patient-specific material properties and wall thicknesses were made available from a previous study where uniaxial tensile testing was performed on tissue samples obtained from the same patients. The ATAA wall models were discretised with hexahedral elements and prestressed. For each ATAA model, FE simulations were conducted using patient-specific material properties and wall thicknesses, and group-mean values derived from all tissue samples included in the same experimental study. Literature-based material property and wall thickness were also obtained from the literature and applied to 4 representative cases. Additional FE simulations were performed on these 4 cases by employing group-mean and literature-based wall thicknesses. Results FE simulations using the group-mean material property produced peak wall stresses comparable to those obtained using patient-specific material properties, with a mean deviation of 7.8%. Peak wall stresses differed by 20.8% and 18.7% in patients with exceptionally stiff or compliant walls, respectively. Comparison to results using literature-based material properties revealed larger discrepancies, ranging from 5.4% to 28.0% (mean 20.1%). Bland-Altman analysis showed significant discrepancies in areas of high wall stress, where wall stress obtained using patient-specific and literature-based properties differed by up to 674 kPa, compared to 227 kPa between patient-specific and group-mean properties. Regarding wall thickness, using the literature-based value resulted in even larger discrepancies in predicted peak stress, ranging from 24.2% to 30.0% (mean 27.3%). Again, using the group-mean wall thickness offered better predictions with a difference less than 5% in three out of four cases. While peak wall stresses were most affected by the choice of mechanical properties or wall thickness, the overall distribution of wall stress hardly changed. Conclusions Our study demonstrated the importance of incorporating patient-specific material properties and wall thickness in FEA for risk prediction of aortic dissection or rupture. Our future efforts will focus on developing inverse methods for non-invasive determination of patient-specific wall material parameters and wall thickness.

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Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms

Cited by 15 publications

References 23 publications

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

The role of the extracellular matrix in the development of heart valve disease: Underestimation or undercomprehension?

The Influence of Material Properties and Wall Thickness on Predicted Wall Stress in Ascending Aortic Aneurysms: A Finite Element Study

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