Ratio of the false lumen to the true lumen is associated with long-term prognosis after surgical repair of acute type A aortic dissection

Igarashi, Takashi; Sato, Yoichi; Satokawa, Hirono; Takase, Shinya; Iwai-Takano, Masumi; Seto, Yuki; Yokoyama, Hitoshi

doi:10.1016/j.xjon.2022.02.025

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…The critical pressure has been shown to be sensitive to T/F LPD: the critical pressure tends to increase as the T/F LPD becomes larger. That is, the critical pressure under zero T/F LPD will be higher than that in cases where T/F LPD is negative, which is frequently observed clinically 38–41 . Secondly, high critical pressure was associated with tears of small depth ratio, such as, t = 0.2 and t = 0.4.…”

Section: Discussionmentioning

confidence: 95%

“…That is, the critical pressure under zero T/F LPD will be higher than that in cases where T/F LPD is negative, which is frequently observed clinically. [38][39][40][41] Secondly, high critical pressure was associated with tears of small depth ratio, such as, t = 0.2 and t = 0.4. The critical pressure was shown sensitive to the depth ratio of the tear in the media: the critical pressure keeps decreasing as the tear moves deeper in the media and it was shown to be as low as 50 kPa when the depth ratio is 0.6.…”

Section: Discussionmentioning

confidence: 99%

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Finite‐element simulation of in‐plane tear propagation in the dissected aorta: Implications for the propagation mechanism

Han

Guo

Gao

et al. 2023

Numer Methods Biomed Eng

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Computer modeling and numerical simulation are essential for understanding the progression of aortic dissection. However, tear propagation has not been properly modeled and simulated. The in‐plane dissection propagation between concentrically distributed elastic lamellae is modeled using the cohesive zone method with a bilinear traction‐separation law. The parameters of cohesive elements are calibrated for the three modes of interfacial damage in the media, enabling quantitative predictions of in‐plane tear propagation. An idealized cylindrical tube‐shaped bilayer thick‐wall model of the aorta is employed to elucidate the influence of geometrical parameters, loading conditions and residual stress on the tear propagation. While the model is capable of replicating that deeper, larger tears are associated with lower critical pressure, new findings include: (i) Larger axial stretch leads to lower critical pressure; (ii) Increased magnitude of residual stress is associated with higher critical pressure; (iii) Pressure difference between true and false lumen alters the critical pressure; (iv) The interfacial damage is mostly opening mode in the axial direction, but shear‐dominated in the circumferential direction; (v) Damage due to the opening mode is associated with smaller fracture energy, which makes it easier to propagate than the shear and the mixed modes. (vi) The deformed shape of the tear, which is related to its geometrical features and loading conditions, modulates the critical pressure via two pathways: (a) deformed shapes are associated with specific modes of damage, which influences the critical pressure, and (b) deformed shapes modulate the critical pressure directly via geometrical constraints.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Finite‐element simulation of in‐plane tear propagation in the dissected aorta: Implications for the propagation mechanism

Han

Guo

Gao

et al. 2023

Numer Methods Biomed Eng

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“…The most frequent indication for elective reoperation after ATAAD surgery is distal aneurysm progression, which may result either from expansion of the false lumen (figure 5A–E, in DeBakey type I) or progression of an aneurysm of the non-dissected descending aorta. Progressive false lumen expansion is associated with the number of false lumina, number of true–false lumen fenestrations, retrograde false lumen flow pattern and an increased false:true lumen ratio, among others 32–34. Especially false lumen patency predisposes to growth and is observed in 43%–67% of patients after primary ATAAD repair and related to increased 10 year mortality 35.…”

Section: Late Distal Complicationsmentioning

confidence: 99%

Imaging surveillance for complications after primary surgery for type A aortic dissection

Schalla

Ramaekers

Bidar

et al. 2022

Heart

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Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergency surgery to avert fatal outcome. Conventional surgical procedures comprise excision of the entry tear and replacement of the proximal aorta with a synthetic vascular graft. In patients with DeBakey type I dissection, this approach leaves a chronically dissected distal aorta, putting them at risk for progressive dilatation, dissection propagation and aortic rupture. Therefore, ATAAD survivors should undergo serial imaging for evaluation of the aortic valve, proximal and distal anastomoses, and the aortic segments beyond the distal anastomosis. The current narrative review aims to describe potential complications in the early and late phases after ATAAD surgery, with focus on their specific imaging findings.

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“…In this issue of the Journal , Igarashi and colleagues 5 at Fukushima Medical University reviewed 74 patients at their hospital between 2001 and 2015 who underwent repair for ATAAD and had postoperative computed tomography scan data for comparison. Patients with known connective tissue disorders were excluded from the analysis.…”

mentioning

confidence: 99%

“…Previous studies have suggested a patent false lumen, intimal tear >1 cm in the proximal descending thoracic aorta, location of the intimal tear along the greater curvature, initial total aortic diameter of 40 mm, and an initial false lumen diameter of >22 mm are predictive of subsequent aneurysmal expansion. 4 In this issue of the Journal, Igarashi and colleagues 5 at Fukushima Medical University reviewed 74 patients at their hospital between 2001 and 2015 who underwent repair for ATAAD and had postoperative computed tomography scan data for comparison. Patients with known connective tissue disorders were excluded from the analysis.…”

mentioning

confidence: 99%

Commentary: The correct answer is not true or false, but the ratio might be

Atkins

Reardon

2022

JTCVS Open

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Ratio of the false lumen to the true lumen is associated with long-term prognosis after surgical repair of acute type A aortic dissection

Cited by 5 publications

References 22 publications

Finite‐element simulation of in‐plane tear propagation in the dissected aorta: Implications for the propagation mechanism

Finite‐element simulation of in‐plane tear propagation in the dissected aorta: Implications for the propagation mechanism

Imaging surveillance for complications after primary surgery for type A aortic dissection

Commentary: The correct answer is not true or false, but the ratio might be

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