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

Abstract

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.

Histological and Mechanical Assessment of Decellularized Porcine Biografts, and Its Biological Evaluation following Aortic Implantation during Mid-Term Follow-Up

“…Other authors published similar histological and mechanical findings to ours, examining the effects of the different decellularization methodologies [1, 6]. SDS/NaN 3 (protocol 2) and Triton X-100/sodium deoxycholate/nuclease (protocol 4) treatment were also effective in cell elimination, while mechanical properties showed no remarkable alteration, compared with untreated samples [1, 6].…”

“…SDS/NaN 3 (protocol 2) and Triton X-100/sodium deoxycholate/nuclease (protocol 4) treatment were also effective in cell elimination, while mechanical properties showed no remarkable alteration, compared with untreated samples [1, 6]. In addition, Weymann et al [6] confirmed no significant change in collagen and elastin content using the Biocolor assay, together with significantly reduced DNA content after decellularization using SDS and NaN 3 in PBS with spectrophotometric DNA quantification (protocol 2), supporting superb applicability of this method. Further research with alternative methodology is warranted to better understand the feasibility of this technique in routine use.…”

“…Aortic segments were decellularized through continuous shaking in 1% sodium dodecyl sulfate (SDS; Sigma-Aldrich Chemie Gmbh, Steinheim, Germany), and 0.05% sodium azide (NaN 3 ; Alfa Aesar Gmbh & Co, Karlsruhe, Germany), in PBS (Sigma-Aldrich Chemie Gmbh, Steinheim, Germany), at room temperature, for 48 h. The solution was exchanged every 6 h. At the end of the decellularization protocol, the aortic segments were washed using PBS for 12 h to effectively remove residual detergents and cell debris [6, 7]. …”

Physiological and pathological left ventricular hypertrophy of comparable degree is associated with characteristic differences of in vivo hemodynamics

“…Arterial elastance (Ea) was calculated as LVESP/SV. Ventriculoarterial coupling (VAC) was described by the quotient of Ea and ESPVR (44).…”

Donor Preconditioning After the Onset of Brain Death With Dopamine Derivate n-Octanoyl Dopamine Improves Early Posttransplant Graft Function in the Rat

“…The slope of the enddiastolic pressure-volume relationship (EDPVR) was calculated as a reliable index of LV stiffness. Additionally, arterial elastance (Ea) was calculated, and ventriculo-arterial coupling was described by the quotient of ESPVR and Ea (24).…”