Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Zhu, Peng; Zhou, Pengyu; Xiao, Langtao; Ohene, Bright Eric; Bian, Xiao Ming; Jiang, Xiaoxiao

doi:10.1186/s13019-020-1068-7

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…One patient with ascending aortic dilation is compared against two cases of minimal dilation. Dilation is defined based on the aortic root diameter, where root diameters above 4cm are considered to be dilated [16] (note that criticality of dilation is not addressed here). For this present study, we particularly note the focal area of high wall shear stress on the outer surface of the ascending aorta for the AS patients as shown in the large 4D flow MRI study of Van Ooij et al [6].…”

Section: Scope Of This Workmentioning

confidence: 99%

Wall shear stress and pressure patterns in aortic stenosis patients with and without aortic dilation captured by high-performance image-based computational fluid dynamics

Zolfaghari,

Andiapen,

Baumbach

et al. 2023

PLoS Comput Biol

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Spatial patterns of elevated wall shear stress and pressure due to blood flow past aortic stenosis (AS) are studied using GPU-accelerated patient-specific computational fluid dynamics. Three cases of moderate to severe AS, one with a dilated ascending aorta and two within the normal range (root diameter less than 4cm) are simulated for physiological waveforms obtained from echocardiography. The computational framework is built based on sharp-interface Immersed Boundary Method, where aortic geometries segmented from CT angiograms are integrated into a high-order incompressible Navier–Stokes solver. The key question addressed here is, given the presence of turbulence due to AS which increases wall shear stress (WSS) levels, why some AS patients undergo much less aortic dilation. Recent case studies of AS have linked the existence of an elevated WSS hotspot (due to impingement of AS on the aortic wall) to the dilation process. Herein we further investigate the WSS distribution for cases with and without dilation to understand the possible hemodynamics which may impact the dilation process. We show that the spatial distribution of elevated WSS is significantly more focused for the case with dilation than those without dilation. We further show that this focal area accommodates a persistent pocket of high pressure, which may have contributed to the dilation process through an increased wall-normal forcing. The cases without dilation, on the contrary, showed a rather oscillatory pressure behaviour, with no persistent pressure “buildup” effect. We further argue that a more proximal branching of the aortic arch could explain the lack of a focal area of elevated WSS and pressure, because it interferes with the impingement process due to fluid suction effects. These phenomena are further illustrated using an idealized aortic geometry. We finally show that a restored inflow eliminates the focal area of elevated WSS and pressure zone from the ascending aorta.

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Section: Scope Of This Workmentioning

confidence: 99%

Wall shear stress and pressure patterns in aortic stenosis patients with and without aortic dilation captured by high-performance image-based computational fluid dynamics

Zolfaghari,

Andiapen,

Baumbach

et al. 2023

PLoS Comput Biol

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“…Wrapping, instead of replacement, of the ascending aorta is often performed alongside aortic valve replacement (AVR) in patients with aortic stenosis (AS) and dilated ascending aorta [1]. In a metaanalysis by Ploneck, wrapping was reported to have good long-term aorta-related outcomes, such as low mortality and morbidity [2].…”

Section: Introductionmentioning

confidence: 99%

Long-term fate of the ascending aortic wall after wrapping with polytetrafluoroethylene felt: A case series

Tadokoro

Kitamura

Tamura

et al. 2021

Preprint

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Background: Aortic wrapping aims to prevent aortic enlargement or dissection; it is less invasive than ascending aorta replacement. Several studies have reported low mortality and morbidity rates in patients treated using aortic wrapping. Wrapping is often accompanied by aortic valve replacement, which may require a redo surgery after some years. However, only few reports have focused on the redo surgery after aortic wrapping. We report three such cases of redo surgery in patients who previously underwent aortic wrapping using polytetrafluoroethylene felt.Case presentation: Among the three cases, two were referred with complaints associated with the deterioration of the prosthetic valve, 10 years or longer after the initial surgery. In all the cases, the aortic wall exhibited severe erosion, necessitating replacement of the ascending aorta.Conclusion: The portion of the ascending aortic wall wrapped with polytetrafluoroethylene felt exhibited severe erosion late after surgery. Therefore, ascending aorta graft replacement is highly likely to be necessary in redo surgery performed long after initial ascending aorta wrapping.

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“…нашли свое воплощение и варианты экзопротезирования ВА с сохранением ее собственной стенки (типа Робичека), что позволяет в ряде случаев радикально корригировать патологию при минимальном риске вмешательства, хороших отдаленных результатах, минимальном числе осложнений, не связанных с сосудистым протезным эндокардитом и несостоятельностью анастомозов [2,[4][5][6][7][8]. Тем не менее с целью снижения риска госпитальной летальности и улучшения отдаленных результатов поиски оптимальных вариантов экзопротезирования не прекращаются [6,9].…”

Section: Introductionunclassified

Методика Тесемочного Бандажа Восходящей Аорты При Ее Постстенотическом Расширении Во Время Коррекции Аортального Стеноза

Попов¹,

Bolshak²,

Рой³

et al. 2021

Кардиология В Беларуси

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Цель. Изучить клинические возможности оригинальной методики тесемочного бандажа восходящей аорты (ВА) при ее постстенотическом расширении при хирургической коррекции аортального стеноза (АС). Материалы и методы. В исследуемую группу включены 196 пациентов, которые были прооперированы по поводу преобладающего АС в сочетании с постстенотическим расширением восходящей аорты (ПРВА). Средний возраст оперированных составил 58,9±9,4 года. При эхокардиографическом исследовании диаметр ВА до операции составлял 47,7±1,7 мм. Диаметр синусов Вальсальвы составил 37,4±1,8 мм. Всем пациентам выполнено протезирование аортального клапана (ПАК) в сочетании с комплексным тесемочным окутыванием ВА. Предложенная методика хирургической коррекции ПРВА включала в себя пликацию синуса Вальсальвы некоронарной створки, уменьшение диаметра ВА, создание ее наружного каркаса от корня с целью профилактики дальнейшей дилатации в отдаленные сроки после операции. Результаты. Госпитальная летальность составила 0,5%. Специфических осложнений, связанных с манипуляциями на корне аорты и ВА, отмечено не было. Диаметр ВА на момент выписки составлял 39,1±1,5 мм, в отдаленном периоде - 40,3±1,1 мм, а диаметр синусов Вальсальвы - 34,5±1,5 мм и 34,8±1,3 мм соответственно. При гистологическом исследовании стенки ВА не было выявлено значимой разницы в ее структуре в зависимости от степени дилатации (диаметр ВА от 4,3 до 5,6 см). Заключение. Методика продемонстрировала свою безопасность на госпитальном этапе и надежность в отдаленном послеоперационном периоде. На основании полученного клинического опыта представляется целесообразным рекомендовать оригинальную методику тесемочного окутывания ВА при наличии ПРВА во время хирургической коррекции преобладающего АС. Purpose. To study the clinical possibilities of the original technique of the wrap bandage of the ascending aorta (AA) in its poststenotic dilation during surgical correction of aortic stenosis (AS). Materials and methods. The study group included 196 patients, who were operated on for the prevailing AS in combination with poststenotic dilation of the ascending aorta (PDAA). The average age of the operated patients was 58.9±9.4 years. During echocardiographic examination, the diameter of the AA before surgery was 47.7±1.7 mm. The diameter of the Valsalva sinuses was 37.4±1.8 mm. All patients underwent aortic valve replacement (AVR) in combination with a comprehensive wrapping of AA. The proposed technique for surgical correction of the PDAA included plication of the Valsalva sinus of the noncoronary cusp, reduction of the AA’s diameter, creation of its outer frame from the root in order to prevent further dilatation in the long term after the operation. Results. Hospital mortality was 0.5%. There were no specific complications associated with manipulations on the aortic root and AA. The diameter of the AA at the time of discharge was 39.1±1.5 mmand in the long-term - 40.3±1.1mm, and the diameter of the Valsalva sinuses was 34.5±1.5 mm and 34.8±1.3 mm, respectively. Histological examination of the AA’s wall did not reveal a significant difference in its structure depending on the degree of dilation (diameter of AA from 4.3 to 5.6 cm). Conclusion. The technique has demonstrated its safety at the hospital stage and reliability at the long-term postoperative period. On the base of the gained clinical experience, it seems advisable to recommend the original technique of wrapping the AA in the presence of PDAA during surgical correction of the prevailing AS.

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Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Cited by 6 publications

References 27 publications

Wall shear stress and pressure patterns in aortic stenosis patients with and without aortic dilation captured by high-performance image-based computational fluid dynamics

Wall shear stress and pressure patterns in aortic stenosis patients with and without aortic dilation captured by high-performance image-based computational fluid dynamics

Long-term fate of the ascending aortic wall after wrapping with polytetrafluoroethylene felt: A case series

Методика Тесемочного Бандажа Восходящей Аорты При Ее Постстенотическом Расширении Во Время Коррекции Аортального Стеноза

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