scholarly journals In Vitro Quantification of Stent-Graft Behaviour During ch-TEVAR

2020 ◽  
Author(s):  
Jakub Kwiecinski ◽  
Raman Uberoi ◽  
Mohammed Hadi ◽  
Christopher P. Cheng ◽  
Zhong You
Keyword(s):  
Cardiac Cycle ◽  
Physiological Model ◽  
Aortic Pressure ◽  
Spatial And Temporal Variability ◽  
Brachiocephalic Trunk ◽  
Device Type ◽  
Surface Deviation ◽  
Substantial Change ◽  
Chimney Graft

Purpose: To quantify dynamic gutter phenomena and endograft deformations during double chimney thoracic endovascular aortic repair (ch-TEVAR) in a physiological model of the thoracic aorta subjected to pulsatile haemodynamic conditions. Methods: Two in vitro procedures revascularizing the brachiocephalic trunk and left common carotid artery were performed representing both balloon-expandable (BE, Ankura-BeGraft) and self-expandable (SE, Ankura-Viabahn) double ch-TEVAR configurations. Retrospectively gated computed tomography (CT) was used to evaluate endograft behaviour. Device interactions were characterised according to gutter volume, gutter surface deviation, and endograft deformation (D-ratio) at end-diastolic and peak-systolic aortic pressure. Results: Use of BE chimney grafts resulted in three times total gutter volume compared to SE chimney grafts. Gutter volumes were observed to vary dynamically between the end-diastolic and peak-systolic phases of the cardiac cycle, with the most substantial change associated with the BE configuration. Chimney graft deformations were dependent on device type, with SE devices exhibiting up to twice the deformation as BE devices. When adjacent, SE chimney grafts were observed to support each other, and thus tended towards a more consistently circular shape. Conclusions: Gutter and chimney graft behaviour were dependent on device type, and exhibited both spatial and temporal variability. This study emphasizes notable differences between BE and SE double ch-TEVAR configurations which should be considered when evaluating risk of endoleak. The findings reported here also support the use of gated CT to better identify and predict device related complications in ch-TEVAR, and can be used in the design of next generation devices.

In Vitro Quantification of Gutter Formation and Chimney Graft Compression in Chimney EVAR Stent-Graft Configurations Using Electrocardiography-Gated Computed Tomography

2018 ◽  
Vol 25 (3) ◽  
pp. 387-394 ◽  
Author(s):  
Simon P. Overeem ◽  
Esmé J. Donselaar ◽  
Jorrit T. Boersen ◽  
Erik Groot Jebbink ◽  
Cornelis H. Slump ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Stent Graft ◽  
Cardiac Cycle ◽  
Intraclass Correlation ◽  
Endovascular Aneurysm Repair ◽  
Enhanced Computed Tomography ◽  
Geometric Changes ◽  
Aneurysm Repair ◽  
Chimney Graft

Purpose: To assess the dynamic behavior of chimney grafts during the cardiac cycle. Methods: Three chimney endovascular aneurysm repair (EVAR) stent-graft configurations (Endurant and Advanta V12, Endurant and Viabahn, and Endurant and BeGraft) were placed in silicone aneurysm models and subjected to physiologic flow. Electrocardiography (ECG)-gated contrast-enhanced computed tomography was used to visualize geometric changes during the cardiac cycle. Endograft and chimney graft surface, gutter volume, chimney graft angulation over the center lumen line, and the D-ratio (the ratio between the lengths of the major and minor axes) were independently assessed by 2 observers at 10 time points in the cardiac cycle. Results: Both gutter volumes and chimney graft geometry changed significantly during the cardiac cycle in all 3 configurations (p<0.001). Gutters and endoleaks were observed in all configurations. The largest gutter volume (232.8 mm3) and change in volume (20.7 mm3) between systole and diastole were observed in the Endurant-Advanta configuration. These values were 2.7- and 3.0-fold higher, respectively, compared to the Endurant-Viabahn configuration and 1.7- and 1.6-fold higher as observed in the Endurant-BeGraft configuration. The Endurant-Viabahn configuration had the highest D-ratio (right, 1.26–1.35; left, 1.33–1.48), while the Endurant-BeGraft configuration had the lowest (right, 1.11–1.17; left, 1.08–1.15). Assessment of the interobserver variability showed a high correlation (intraclass correlation >0.935) between measurements. Conclusion: Gutter volumes and stent compression are dynamic phenomena that reshape during the cardiac cycle. Compelling differences were observed during the cardiac cycle in all configurations, with the self-expanding (Endurant–Viabahn) chimney EVAR configurations having smaller gutters and less variation in gutter volume during the cardiac cycle yet more stent compression without affecting the chimney graft surface.

Modeling Endoleaks and Collateral Reperfusion following Endovascular AAA Exclusion

2003 ◽  
Vol 10 (3) ◽  
pp. 424-432 ◽  
Author(s):  
Chuh K. Chong ◽  
Thien V. How ◽  
Geoffrey L. Gilling-Smith ◽  
Peter L. Harris
Keyword(s):  
Stent Graft ◽  
Aortic Pressure ◽  
Type I ◽  
Type Ii ◽  
Pump System ◽  
Type Ii Endoleak ◽  
Type I Endoleak ◽  
The Impact ◽  
Mean Aortic Pressure

Purpose: To investigate the effect on intrasac pressure of stent-graft deployment within a life-size silicone rubber model of an abdominal aortic aneurysm (AAA) maintained under physiological conditions of pressure and flow. Methods: A commercial bifurcated device with the polyester fabric preclotted with gelatin was deployed in the AAA model. A pump system generated physiological flow. Mean and pulse aortic and intrasac pressures were measured simultaneously using pressure transducers. To simulate a type I endoleak, plastic tubing was placed between the aortic wall and the stent-graft at the proximal anchoring site. Type II endoleak was simulated by means of side branches with set inflow and outflow pressures and perfusion rates. Type IV endoleak was replicated by removal of gelatin from the graft fabric. Results: With no endoleak, the coated graft reduced the mean and pulse sac pressures to negligible values. When a type I endoleak was present, mean sac pressure reached a value similar to mean aortic pressure. When net flow through the sac due to a type II endoleak was present, mean sac pressure was a function of the inlet pressure, while pulse pressure in the sac was dependent on both inlet and outlet pressures. As perfusion rates increased, both mean and pulse sac pressures decreased. When there was no outflow, mean sac pressure was similar to mean aortic pressure. In the presence of both type I and type II endoleaks, mean sac pressure reached mean aortic pressure when the net perfusion rate was low. Conclusions: In vitro studies are useful in gaining an understanding of the impact of different types of endoleaks, in isolation and in combination, on intrasac pressure after aortic stent-graft deployment.

Nervous control of the heartbeat in octopus

1980 ◽  
Vol 85 (1) ◽  
pp. 111-128 ◽  
Author(s):  
M. J. Wells
Keyword(s):  
Circulatory System ◽  
Aortic Pressure ◽  
Surgical Removal ◽  
Cardiac Ganglion ◽  
Nervous Control ◽  
Cardiac Ganglia ◽  
Before And After ◽  
Branchial Heart ◽  
Systemic Heart

The circulatory system of cephalopods is based on a trio of hearts, with two pairs of associated ganglia linked to the CNS by a pair of visceral nerves. The beat of the hearts was recorded from free-moving octopuses before and after surgical removal or disconnexion of elements of the nervous system. Severing the visceral nerves does not stop the hearts, which continue to beat in a powerful well co-ordinated manner in isolation from the CNS. The nerves seem to be concerned in raising the cardiac output in exercise, and with stopping the hearts when mantle movements cease, but they are not necessary for the initiation of maintenance of the normal rhythm. Removal of the fusiform ganglia severs all nervous connexions between the ywo gill hearts, and deprives the systemic heart of its nerve supply. The trio of hearts continues to beat as strongly as before. Removal or disconnexion of a cardiac ganglion disrupts the beat of the corresponding gill heart which now tends to contract in an ill-coordinated and rather feeble manner, though at much the same frequency as before; with both cardiacs gone the systemic heart, which contracts only when it is filled, tends to drop in frequency and the mean aortic pressure falls. The system remains rhythmic, however, and the beat may recover, to the point where aortic pressures and frequencies approach those found in intact animals at rest; even octopuses with both fusiform and both cardiac ganglia removed can survive for many hours. From the performance of the isolated branchial heart, the existence of a pulsating vesicle in each cardiac ganglion, the effects of cardiac ganglion removal and the remarkable steadiness of heartbeat frequency shown by intact animals under a variety of conditions, it is argued that the heartbeat rhythm is normally controlled by pacemakers in the branchial heart/ cardiac ganglion complexes, and perhaps, in intact animals, from within the cardiac ganglia themselves. The picture of the control of the heartbeat that emerges from the study of free moving essentially intact animals is quite different from that arising from in vitro and acute preparation studies. It suggests that the conventional wisdom about the control of the heartbeat in cephalopods (and perhaps by implication, in other molluscs) may need to be considerably revised.

Experimental Analysis of Pulsatile Flow Through Elastic Collapsible Tubes: Application to Cardiac Assist Device

1990 ◽  
Vol 112 (1) ◽  
pp. 75-79 ◽  
Author(s):  
O. Lichtenstein ◽  
U. Dinnar
Keyword(s):  
Systemic Circulation ◽  
Aortic Pressure ◽  
Assist Device ◽  
Cardiac Assist ◽  
Cardiac Assist Device ◽  
Non Invasive ◽  
Failing Heart ◽  
In Series ◽  
Vitro Analysis

This study presents a simulated analysis of Phased Compression Cardiac Assist Device (PCCAD) and evaluation of its applicability as a non-invasive temporary assist for a failing heart. The new technique is based on the chest pump mechanism for blood flow augmentation during external massage by phased compression of the abdominal and thoracic cavities. A semi-closed hydraulic system to simulate the systemic circulation was constructed; the system includes a left ventricle which functions according to the Starling principle and a pneumatic system which controls the pressures applied to the thoracic and abdominal cavities, in complete synchronization with the beating normal or failing heart. The possibility of manipulating the three pumps in series (venous, heart, and arterial) has been checked, and the principal parameters which effect the efficiency of the PCCAD were evaluated. This in-vitro analysis shows the high potential of a non-invasive temporary cardiac assist device. It points to the necessary measures one has to take in order to achieve good synchronization and to interfere externally with the augmentation of cardiac output or with the augmentation of root aortic pressure.

Effects of natriuretic peptides and nitroprusside on venous function in trout

1997 ◽  
Vol 273 (2) ◽  
pp. R527-R539 ◽  
Author(s):  
K. R. Olson ◽  
D. J. Conklin ◽  
A. P. Farrell ◽  
J. E. Keen ◽  
Y. Takei ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Aortic Pressure ◽  
Systemic Resistance ◽  
Venous Compliance ◽  
Venous Capacitance ◽  
Unstressed Volume ◽  
Ventral Aorta

Active venous regulation of cardiovascular function is well known in mammals but has not been demonstrated in fish. In the present studies, the natriuretic peptides (NP) rat atrial natriuretic peptide (ANP) and trout ventricular natriuretic peptide (VNP), clearance receptor inhibitor SC-46542, and sodium nitroprusside (SNP) were infused into unanesthetized trout fitted with pressure cannulas in the ventral aorta, dorsal aorta, and ductus Cuvier, and a ventral aorta (VA) flow probe was used to measure cardiac output (CO). In another group, in vivo vascular (venous) capacitance curves were obtained during ANP or SNP infusion. The in vitro effects of NP on vessels and the heart were also examined. ANP, VNP, and SC-46542 decreased central venous pressure (PVen), CO, stroke volume (SV), and gill resistance (RG), whereas systemic resistance (RS) and heart rate (HR) increased. Dorsal aortic pressure (PDA) transiently increased and then fell even though RS remained elevated. ANP decreased mean circulatory filling pressure (MCFP), increased vascular compliance at all blood volumes, and increased unstressed volume in hypovolemic fish. ANP had no direct effect on the heart. ANP responses in vivo were not altered in trout made hypotensive by prior treatment with the angiotensin-converting enzyme inhibitor lisinopril. SNP reduced ventral aortic pressure (PVA), PDA, and RS, increased CO and HR, but did not affect PVen, SV, or RG. SNP slightly decreased MCFP but did not affect compliance or unstressed volume. In vitro, large systemic arteries were more responsive than veins to NP, whereas SNP relaxed both. These results show that, in vivo, NP decrease venous compliance, thereby decreasing venous return, CO, and arterial pressure. Conversely, SNP hypotension is due to decreased RS. This is the first evidence for active regulation of venous capacitance in fish, which probably occurs in small veins or venules. The presence of venous baroreceptors is also suggested.

Geometric Study of Various Chimney Graft Configurations in an In Vitro Juxtarenal Aneurysm Model

2013 ◽  
Vol 20 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Jorg L. de Bruin ◽  
Kak K. Yeung ◽  
Wouter W. Niepoth ◽  
Rutger J. Lely ◽  
Qingfeng Cheung ◽  
...  
Keyword(s):  
Juxtarenal Aneurysm ◽  
Chimney Graft ◽  
Aneurysm Model ◽  
Geometric Study

Variations in Aortic Pressure Affect the Mechanics of the Intra-Aortic Balloon: An In Vitro Investigation

2010 ◽  
Vol 34 (7) ◽  
pp. 546-553 ◽  
Author(s):  
Giovanni Biglino ◽  
Christina Kolyva ◽  
Michael Whitehorne ◽  
John R. Pepper ◽  
Ashraf W. Khir
Keyword(s):  
Aortic Pressure ◽  
In Vitro Investigation

Decreased expression of myocardial eNOS and caveolin in dogs with hypertrophic cardiomyopathy

2002 ◽  
Vol 282 (1) ◽  
pp. H219-H231 ◽  
Author(s):  
A. Piech ◽  
P. E. Massart ◽  
C. Dessy ◽  
O. Feron ◽  
X. Havaux ◽  
...  
Keyword(s):  
Systolic Function ◽  
Critical Role ◽  
Aortic Pressure ◽  
Heart Tissue ◽  
Caveolin 1 ◽  
Calcium Dependent ◽  
Diastolic Relaxation ◽  
Nos Inhibitor

Because nitric oxide (NO) regulates cardiac and vessel contraction, we compared the expression and activity of the endothelial NO synthase (eNOS) and caveolin, which tonically inhibits eNOS in normal and hypertrophic cardiomyopathic hearts. NOS activity (l-[3H]citrulline formation), eNOS immunostaining, and caveolin abundance were measured in heart tissue of 23 mongrel dogs before and at 3 and 7 wk of perinephritic hypertension (PHT). Hemodynamic parameters in vivo and endothelial NO-dependent relaxation of macro- and coronary microvessels in vitro were assessed in the same animals. eNOS immunostaining and total calcium-dependent NOS activity decreased at 7 wk in all four heart cavities (in left ventricle, from 17.0 ± 1.3 to 0.2 ± 0.2 fmol · min−1 · mg protein−1, P < 0.001). Caveolin-1 and -3 also decreased in PHT dog hearts. Accordingly, basal vascular tone was preserved, but maximal endothelial NO-dependent relaxation was impaired in all vessels from 7-wk PHT dogs. The latter had preserved systolic function but impaired diastolic relaxation [relaxation time constant ( T 1), 25.1 ± 0.9 vs. 22.0 ± 1 ms in controls; P < 0.05]. Peripheral infusion of the NOS inhibitor N G -nitro-l-arginine methyl ester increased mean aortic pressure in both groups and reduced diastolic ( T 1, 31.9 ± 1.4 ms) and systolic function in PHT dogs (DP40, 47.5 ± 2.5 vs. 59.4 ± 3.8 s−1 in control animals). In conclusion, both eNOS and caveolin proteins are decreased in the hypertrophic hearts of PHT dogs. This is associated with altered maximal (but not basal) vascular relaxation and impaired diastolic function. Further degradation of cardiac function after NOS inhibition suggests a critical role of residual NOS activity, probably supported by the concurrent downregulation of caveolin.

scholarly journals Flagellin-F1-V Fusion Protein Is an Effective Plague Vaccine in Mice and Two Species of Nonhuman Primates

2008 ◽  
Vol 16 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Steven B. Mizel ◽  
Aaron H. Graff ◽  
Nammalwar Sriranganathan ◽  
Sean Ervin ◽  
Cynthia J. Lees ◽  
...  
Keyword(s):  
Fusion Protein ◽  
Nonhuman Primates ◽  
High Yield ◽  
Protein Vaccine ◽  
Protective Antigens ◽  
Boost Immunization ◽  
Respiratory Challenge ◽  
Toll Like Receptor 5 ◽  
Substantial Change

ABSTRACT A number of studies have clearly demonstrated that flagellin is a potent adjuvant that promotes robust immune responses when it is given with a protein antigen. In view of the potential biological and practical benefits of a recombinant protein vaccine composed of a single fusion protein containing flagellin and antigen, we have evaluated the efficacy of a fusion protein composed of flagellin and two protective antigens of Yersinia pestis (F1 and V) in eliciting protection against respiratory challenge with Y. pestis. Flagellin-F1-V was produced and purified in high yield under good manufacturing practices conditions. The fusion protein retains full Toll-like receptor 5-stimulating activity in vitro. Using a prime-boost immunization protocol, we found that flagellin-F1-V elicits robust antigen-specific humoral immunity in mice and two species of nonhuman primates. Immune mice were fully protected against intranasal challenge with 150 mean tolerated doses of Y. pestis CO92. In immune mice, the bacteria were completely cleared within 3 days after challenge. Flagellin-F1-V exhibited full stability for at least 297 days at 4°C and at least 168 days at 25°C. At between 29 and 84 days at 37°C, the protein exhibited a loss of biological activity that appeared to be associated with a substantial change in protein diameter, possibly due to oligomerization. On the basis of our results, we believe that flagellin-F1-V is an outstanding candidate for evaluation in studies with humans.

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