scholarly journals Comparison of two techniques (in vivo and ex-vivo) for evaluating the elastic properties of the ascending aorta: Prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256278
Author(s):  
Marie-Catherine Morgant ◽  
Siyu Lin ◽  
Diana Marin-Castrillon ◽  
Chloé Bernard ◽  
Aline Laubriet ◽  
...  
Keyword(s):  
Elastic Modulus ◽  
Elastic Properties ◽  
Ex Vivo ◽  
Ascending Aorta ◽  
Patient Specific ◽  
Cine Mri ◽  
Biaxial Tensile ◽  
Biaxial Tests ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Introduction Aneurysms of the ascending aorta (AA) correspond to a dilatation of the ascending aorta that progressively evolves over several years. The main complication of aneurysms of the ascending aorta is type A aortic dissection, which is associated with very high rates of morbidity and mortality. Prophylactic ascending aorta replacement guidelines are currently based on maximal AA diameter. However, this criterion is imperfect. Stretching tests on the aorta carried out ex-vivo make it possible to determine the elastic properties of healthy and aneurysmal aortic fragments (tension test, resistance before rupture). For several years now, cardiac magnetic resonance imaging (MRI) has provided another means of evaluating the elastic properties of the aorta. This imaging technique has the advantage of being non-invasive and of establishing aortic compliance (local measurement of stiffness) without using contrast material by measuring the variation of the aortic surface area during the cardiac cycle, and pulse wave velocity (overall stiffness of the aorta). Materials and methods Prospective single-center study including 100 patients with ascending aortic aneurysm requiring surgery. We will perform preoperative cine-MRI and biomechanical laboratory stretching tests on aortic samples collected during the cardiac procedure. Images will be acquired with a 3T MRI with only four other acquisitions in addition to the conventional protocol. These additional sequences are a Fast Low Angle Shot (FLASH)-type sequence performed during a short breath-hold in the transverse plane at the level of the bifurcation of the pulmonary artery, and phase-contrast sequences that encodes velocity at the same localization, and also in planes perpendicular to the aorta at the levels of the sino-tubular junction and the diaphragm for the descending aorta. For ex-vivo tests, the experiments will be carried out by a biaxial tensile test machine (ElectroForce®). Each specimen will be stretched with 10 times of 10% preconditioning and at a rate of 10 mm/min until rupture. During the experiment, the tissue is treated under a 37°C saline bath. The maximum elastic modulus from each sample will be calculated. Results The aim of this study is to obtain local patient-specific elastic modulus distribution of the ascending aorta from biaxial tensile tests and to assess elastic properties of the aorta using MRI, then to evaluate the correlation between biaxial tests and MRI measurements. Discussion Our research hypothesis is that there is a correlation between the evaluation of the elastic properties of the aorta from cardiac MRI and from stretching tests performed ex-vivo on aorta samples collected during ascending aorta replacement.

Partial Clamping of the Brachiocephalic Trunk for Total Ascending Aorta Replacement without Circulatory Arrest: Early and Midterm Results

2004 ◽  
Vol 7 (3) ◽  
pp. E201-E207
Author(s):  
Antonio Maria Calafiore ◽  
Michele Di Mauro ◽  
Carlos-A. Mestres ◽  
Gabriele Di Giammarco ◽  
Giovanni Teodori ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Ascending Aorta ◽  
Midterm Results ◽  
Brachiocephalic Trunk ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Intravascular Ultrasound Findings of BioGlue Surgical Adhesive Coronary Embolism After Ascending Aorta Replacement

2021 ◽  
Vol 14 (4) ◽  
pp. e39-e41
Author(s):  
Masashi Yokoi ◽  
Hiroshi Fujita ◽  
Tatsuhito Ogawa ◽  
Tsuyoshi Ito ◽  
Yoshihiro Seo ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Ascending Aorta ◽  
Surgical Adhesive ◽  
Ultrasound Findings ◽  
Aorta Replacement ◽  
Coronary Embolism ◽  
Ascending Aorta Replacement

Early safety performance of a modified technique of aorta replacement with sinotubular stabilization

2021 ◽  
pp. 021849232110150
Author(s):  
Marco Moscarelli ◽  
Nicola Di Bari ◽  
Giuseppe Nasso ◽  
Khalil Fattouch ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Safety Performance ◽  
Modified Technique ◽  
Sinotubular Junction ◽  
Aorta Replacement ◽  
Valve Sparing ◽  
Ascending Aorta Replacement

Background We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). Results From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. Conclusions This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up.

scholarly journals Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement

2020 ◽  
Author(s):  
Alessandro Verzini ◽  
Marta Bargagna ◽  
Guido Ascione ◽  
Alessandra Sala ◽  
Davide Carino ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Term Survival ◽  
Kaplan Meier ◽  
Aortic Root Surgery ◽  
Increased Risk ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

Anesthetic management for ascending aorta replacement in a patient who refused autologous transfusion for religious reasons

2009 ◽  
Vol 23 (3) ◽  
pp. 436-438 ◽  
Author(s):  
Shinju Obara ◽  
Masayuki Nakagawa ◽  
Shinichiro Takahashi ◽  
Masahiko Akatu ◽  
Tsuyoshi Isosu ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Ascending Aorta ◽  
Autologous Transfusion ◽  
Aorta Replacement ◽  
Religious Reasons ◽  
Ascending Aorta Replacement

Even redo ascending aorta replacement has low mortality in elective setting

2019 ◽  
Vol 60 (1) ◽  
Author(s):  
Seyed H. Aalaei-Andabili ◽  
Tomas Martin ◽  
Philip Hess ◽  
Teng Lee ◽  
George Arnaoutakis ◽  
...  
Keyword(s):  
Ascending Aorta ◽  
Elective Setting ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

scholarly journals Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery?

2020 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Ziyad Gunga ◽  
Lars Niclauss ◽  
Dominique Delay ◽  
Aurelian Roumy ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Survival Benefit ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Maximum Diameter ◽  
Type A Aortic Dissection ◽  
Aorta Replacement ◽  
Current Guidelines ◽  
Ascending Aorta Replacement

Abstract OBJECTIVES Current guidelines recommend prophylactic replacement of the ascending aorta at an aneurysmal diameter of &gt;55 mm to prevent acute Type A aortic dissection (TAAD) in non-Marfan patients. Several publications have challenged this threshold, suggesting that surgery should be performed in smaller aneurysms to prevent this devastating disease. We reviewed our experience with measuring aortic size at the time of TAAD to validate the existing recommendation for prophylactic ascending aorta replacement. METHODS All patients who had been admitted for TAAD to our emergency department from 2014 to 2019 and underwent ascending aorta replacement were included. Marfan patients were excluded. The maximum diameter of the dissected aorta was measured preoperatively using CT scan. We estimated the aortic diameter at the time of dissection to be 7 mm smaller than the measured maximum diameter of the dissected aorta (modelled pre-dissection diameter). RESULTS Overall, 102 patients were included. Of these, 67 were male (65.6%) and 35 were female (34.4%), and the cohort’s mean age was 65 ± 12.1 years. In addition, 66% were treated for arterial hypertension. The mean maximum modelled pre-dissection diameter was 39.6 ± 4.8 mm: 39.1 ± 5.1 mm in men and 40.7 ± 2.8 mm in women (P = 0.1). The cumulative 30-day mortality rate was 19.6% (20/102). CONCLUSIONS TAAD occurred at a modelled aortic diameter below 45 mm in 87.7% of our patients. Therefore, the current aortic diameter threshold of 55 mm excludes ∼99% of patients with TAAD from prophylactic replacement of the ascending aorta. The maximum diameter of the ascending aorta warrants reappraisal and this parameter should be a distinct part of a personalized decision-making process that also takes into account age, gender and body surface area to establish the surgical indication for preventive aorta replacement aimed to improve the survival benefit of this procedure.

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