Acute Type A Aortic Dissection: Managing More Than Just the Entry-Tear

Houben, Ignas B; Patel, Himanshu J.

doi:10.1053/j.semtcvs.2018.08.011

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…That is, we do not know the specific state of blood flow under different cannulation modes. TAAD is a complex entity, for example, the entry and re-entry tear, extension of dissection, and the involvement of visceral vessels (13). Therefore, it is difficult to understand the complexities of flow dynamic perfusion.…”

Section: Introductionmentioning

confidence: 99%

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

et al. 2021

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Background:The aim of the present study was to use a numerical simulation based on computational fluid dynamics (CFD) to analyze the difference of different cannulation methods on hemodynamics characteristic in a type A aortic dissection (TAAD) model. Methods:A finite-element analysis based on the CFD model of a TAAD patient was used, and axillary artery cannulation (AAC), innominate artery cannulation (IAC), and femoral artery cannulation (FAC) were analyzed under different situations, including a cardiac output (CO) of 2.5 L/min and cardiopulmonary bypass (CPB) of 2.5 L/min (partial CPB before cross-clamping aorta, defined as condition A), and a CO of 0 L/min and CPB of 5 L/min (aortic cross-clamping phase, defined as condition B). The insertion of an 8-mm cannula into the different models was simulated. Hemodynamic characteristics, including wall shear stress, wall stress, blood flow, and velocity were analyzed.Results: In condition A, the total flow of branches of the aortic arch was 2,009.5 mL/min (AAC), 1,855.47 mL/min (IAC), and 1,648.03 mL/min (FAC). All cannulation methods improved left renal blood perfusion. However, in relation to blood flow in the right renal artery, FAC showed the highest blood flow (105 mL/min). The results in condition B were similar to those of condition A. The velocity, shear stress, and stress of entry tear via AAC and IAC decreased in condition B compared with condition A. The velocity, shear stress, stress of tear via AAC was lower than that of IAC.Conclusions: Different cannulation modes have an effect on the hemodynamic characteristic of the tear, but this effect is related to different states of CPB. AAC was found to superior to IAC, especially in reducing velocity, stress, and shear stress of site of tear. However, IAC and AAC are more conductive to blood supply than FAC in branch vessels of the aortic arch without being affected by the CPB state.

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Section: Introductionmentioning

confidence: 99%

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

et al. 2021

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“…This difference has been attributed to thickening and stiffening of the intimal flap over time, 7 increasing the risk of endograft related complications 8 . Following these results, early detection of adverse aortic remodeling is desirable to identify patients who will require aortic repair during follow‐up 9 . Currently, diameter measurements of the aortic lumen are the mainstay measurement technique for the assessment of aortic geometry over time.…”

Section: Introductionmentioning

confidence: 99%

“…8 Following these results, early detection of adverse aortic remodeling is desirable to identify patients who will require aortic repair during follow-up. 9 Currently, diameter measurements of the aortic lumen are the mainstay measurement technique for the assessment of aortic geometry over time.…”

Section: Introductionmentioning

confidence: 99%

Critical appraisal of multidimensional CT measurements following acute open repair of type A aortic dissection

et al. 2020

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Introduction To identify patients with aneurysmal degeneration of the native aorta following type A aortic dissection (TAAD), reproducible serial measurements of aortic dimensions are critical. We used a systematic workflow for measuring aortic geometry following TAAD, using computed tomography angiography data, and test its reproducibility. Methods The workflow for aortic measurements included centerline generation, luminal diameter, and area measurement at six anatomically defined locations along the aorta and luminal volumetric measurements in the descending aorta. Two independent observers measured the aortic geometry in 20 surgically repaired TAAD patients, preoperatively and at 3 months follow‐up. To test reproducibility, intraobserver and interobserver agreement scores were analyzed using a concordance correlation coefficient (CCC). Results The interobserver agreement scores of the diameter, area, and volumetric measurements in the descending aorta were acceptable. The agreement scores of the area measurements were highest, with CCCs ranging from 0.909 to 0.984. Luminal diameter measurements scored lower than luminal area measurements and were least reproducible at the mid aortic arch (CCC < 0.886). Overall, intraobserver agreement scores were better than interobserver agreement scores (SD of mean difference was 1.89 vs 1.94 for intraobserver vs interobserver diameter measurements, and 0.61 vs 0.66 for area measurements). Conclusion Although overall reproducibility was acceptable in descending aortic measurements, our results show that it remains challenging to reliably measure luminal diameters, compared with areas. To aid identification of early adverse remodeling following acute TAAD, novel two‐ and three‐dimensional measurement techniques are needed that capture locoregional changes in the false lumen and true lumen morphology more accurately.

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