Simulation of arterial hemodynamics after partial prosthetic replacement of the aorta

Bauernschmitt, Robert; Schulz, Stephan; Schwarzhaupt, A; Kiencke, Uwe; Vahl, Christian‐Friedrich; Lange, Rüdiger; Hagl, S.

doi:10.1016/s0003-4975(99)00046-6

Cited by 27 publications

(17 citation statements)

References 10 publications

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“…6). Although RIN (zero harmonics, an equivalent of TPR) showed decreased values after replacement, vascular impedance at harmonics between 1 and 6Hz was markedly increased in the prosthesis group, which is in line with previous studies [11]. This indicates an increased stiffness of the central arterial system and partial loss of the aortic Windkessel function and can be attributed to the synthetic Dacron material with strongly limited elastic properties compared to the native aortic arch.…”

Section: Discussionsupporting

confidence: 90%

Total Aortic Arch Replacement: Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses

et al. 2014

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BackgroundTo date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts.MethodsAfter preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group). Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees), arterial elastance (Ea) and ventriculoarterial coupling were calculated. Characteristic impedance (Z) was assessed by Fourier analysis.ResultsWhile Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL), Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05) in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL). This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%). Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3dyn·sec·cm−5 vs. 32.4±2.0dyn·sec·cm−5, P<0.05).ConclusionsTotal aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving ventriculoarterial mechanoenergetics after aortic arch replacement.

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Section: Discussionsupporting

confidence: 90%

Total Aortic Arch Replacement: Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses

et al. 2014

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“…Our results are consistent with prior research employing computational simulation and animal models [10,[27][28][29]. In an ex-vivo study for which explanted porcine aortas were studied under mock circulatory conditions, Scharfschwerdt et al demonstrated that prosthetic graft replacement of the ascending aorta increased distal aortic systolic pressure and wall tension [27].…”

Section: Plos Onesupporting

confidence: 91%

Prosthetic aortic graft replacement of the ascending thoracic aorta alters biomechanics of the native descending aorta as assessed by transthoracic echocardiography

et al. 2020

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The funders had no role in study design, data collection and greater wall thickness, and higher prevalence of calcific atherosclerotic plaque in the degenerative group (all p<0.05). In multivariate analysis, congenital/genetically associated AA etiology conferred a 4-fold increment in magnitude of augmented native descending aortic strain after proximal grafting (B = 4.19 [CI 1.6, 6.8]; p = 0.002) independent of age and descending aortic size. Conclusions Prosthetic graft replacement of the ascending aorta increases magnitude and rapidity of distal aortic distension. Graft effects are greatest with congenital or genetically associated AA, providing a potential mechanism for increased energy transmission to the native descending aorta and adverse post-surgical aortic remodeling.

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“…Aortic reconstruction with a prosthetic noncompliant graft reduces this compliance and may have an adverse effect on cardiovascular hemodynamics, which in turn may lead to hypertension, cardiac hypertrophy and ischemia, the development of vessel wall disease and thrombosis formation [2,3,4,5,6,7,8]. Furthermore, the different radial dilation of the prosthesis and the host vessel leads to stress concentration in the sutures of the anastomoses, which may lead to fatigue failure of the suture line and tearing of the host artery resulting in anastomotic aneurysm formation [7].…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Hypertrophy Induced by Reduced Aortic Compliance

et al. 2009

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Aim: It was the aim of this study to investigate the long- term effects of reduced aortic compliance on cardiovascular hemodynamics and cardiac remodeling. Method: Sixteen swine, divided into 2 groups, a control and a banding group, were instrumented for pressure and flow measurement in the ascending aorta. Teflon prosthesis was wrapped around the aortic arch in order to limit wall compliance in the banding group. Hemodynamic parameters were recorded throughout a 60-day period. After sacrifice, the mean cell surface of the left ventricle was documented. Results: Banding decreased aortic compliance by 49 ± 9, 44 ± 16 and 42 ± 7% on the 2nd, 30th and 60th postoperative day, respectively (p < 0.05), while systolic pressure increased by 41 ± 11, 30 ± 11 and 35 ± 12% (p < 0.05), and pulse pressure by 86 ± 27, 76 ± 21 and 88 ± 23%, respectively (p < 0.01). Aortic characteristic impedance increased significantly in the banding group. Diastolic pressure, cardiac output and peripheral resistance remained unaltered. The mean left ventricular cell surface area increased significantly in the banding group. Conclusions: Acute reduction in aortic compliance results in a significant increase in characteristic and input impedance, a significant decrease in systemic arterial compliance and a subsequent increase in systolic and pulse pressures leading to left ventricular hypertrophy.

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Simulation of arterial hemodynamics after partial prosthetic replacement of the aorta

Cited by 27 publications

References 10 publications

Total Aortic Arch Replacement: Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses

Total Aortic Arch Replacement: Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses

Prosthetic aortic graft replacement of the ascending thoracic aorta alters biomechanics of the native descending aorta as assessed by transthoracic echocardiography

Left Ventricular Hypertrophy Induced by Reduced Aortic Compliance

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