Effect of personalized external aortic root support on aortic root motion and distension in Marfan syndrome patients

İzgi, Cemil; Nyktari, Evangelia; Alpendurada, Francisco; Bruengger, Annina Studer; Pepper, John; Treasure, Tom; Mohiaddin, Raad H.

doi:10.1016/j.ijcard.2015.06.015

Cited by 17 publications

(8 citation statements)

References 34 publications

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“…Repair group : Table 2 and Figure 6 show that the repair group presented smaller and more homogeneous displacements and rotations than the other groups. These findings are consistent with previous studies [ 17 ], indicative of the higher graft stiffness relative to the native aortic tissue [ 18 , 19 ]. Distensibility was also lowest in the repair group, an expected finding given the very stiff properties of synthetic fabric vascular grafts [ 20 , 21 , 22 ].…”

Section: Discussionsupporting

confidence: 93%

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Kim

Tjahjadi

et al. 2023

JCM

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The aorta is in constant motion due to the combination of cyclic loading and unloading with its mechanical coupling to the contractile left ventricle (LV) myocardium. This aortic root motion has been proposed as a marker for aortic disease progression. Aortic root motion extraction techniques have been mostly based on 2D image analysis and have thus lacked a rigorous description of the different components of aortic root motion (e.g., axial versus in-plane). In this study, we utilized a novel technique termed vascular deformation mapping (VDM(D)) to extract 3D aortic root motion from dynamic computed tomography angiography images. Aortic root displacement (axial and in-plane), area ratio and distensibility, axial tilt, aortic rotation, and LV/Ao angles were extracted and compared for four different subject groups: non-aneurysmal, TAA, Marfan, and repair. The repair group showed smaller aortic root displacement, aortic rotation, and distensibility than the other groups. The repair group was also the only group that showed a larger relative in-plane displacement than relative axial displacement. The Marfan group showed the largest heterogeneity in aortic root displacement, distensibility, and age. The non-aneurysmal group showed a negative correlation between age and distensibility, consistent with previous studies. Our results revealed a strong positive correlation between LV/Ao angle and relative axial displacement and a strong negative correlation between LV/Ao angle and relative in-plane displacement. VDM(D)-derived 3D aortic root motion can be used in future studies to define improved boundary conditions for aortic wall stress analysis.

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Section: Discussionsupporting

confidence: 93%

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Kim

Tjahjadi

et al. 2023

JCM

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“…Increase in size is the biggest risk for dissection; PEARS holds the aorta with no further enlargement, so the principal calculable risk is obviated [16]. At the point where the intimal tear is characteristically seen, the aortic wall stress is ameliorated [26]. Drug trials of losartan have thus far failed to halt the progression of root dilatation [27].…”

Section: The Aorta Is Still There and May Dissectmentioning

confidence: 99%

Personalized external aortic root support: a review of the current status

Treasure

Petrou

Rosendahl

et al. 2016

Eur J Cardiothorac Surg

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Personalized external aortic root support (PEARS) is an emerging technology. It is a pre-emptive operation to halt aortic root expansion and maintain aortic valve function in Marfan syndrome and is also applicable to aortic root aneurysms of other aetiologies. To fully evaluate PEARS, awareness of all those who advise these patients is necessary to ensure that patients are fully informed of the alternative operations, to carefully build experience, to ensure safety and quality and to monitor outcomes. Herein, we present a summary of published methods and outcomes and the arrangements in place for fuller evaluation.

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“…Systolic downward aortic root motion and aortic root distension before the operation and in the latest follow-up were measured randomly and blindly after a median follow-up of 50 months (IQR 26-72) following implantation of PEARS. Systolic downward motion of the aortic root was significantly decreased (12.6 ± 3.6 mm pre-operation vs. 7.9 ± 2.9 mm latest followup, p<0.00001) [33] (Figures 12 and 13).…”

Section: Aortic Wall Stress By Mrimentioning

confidence: 94%

“…In a subsequent study, the zerodisplacement constraint at the aortic root was replaced with a systolic downward aortic root motion which revealed the PEARS significantly reduced the maximum longitudinal stress in the ascending aorta (Figure 12). The point of maximum stress and therefore greatest change was in the first few centimetres of the ascending aorta, the site at which the intimal tear of aortic dissection was most likely to occur [33].…”

Section: Aortic Wall Stress By Mrimentioning

confidence: 99%

An integrative approach to the Marfan aortic root between the patient, the physician and basic scientists: A case study in personalised external aortic root support (PEARS)

Golesworthy¹,

Verbrugghe²,

İzgi³

et al. 2016

J Integr Cardiol

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Aortic root aneurysm is a characteristic feature of Marfan syndrome and is the commonest cause of death in the natural history of this condition. Aortic root replacement, introduced in the 1960s and iteratively developed over the subsequent thirty years dramatically improved the prognosis for people with Marfan syndrome. In 2004 a fundamentally different approach was introduced. Rather than surgical resection of the fibrillin deficient aorta, and its replacement with a fabric tube graft, an external support, custom made to the shape and size of the individual's aortic root, was manufactured in preparation for surgery. At operation this is positioned around the aorta extending proximally to the aorto-ventricular junction and distally to beyond the origin of the brachiocephalic artery. This operation has now been done in over 65 patients, mostly with Marfan syndrome, with 270 patient/years of follow-up. The mesh is soft, pliable and macroporous. Histologically the mesh can be seen to become incorporated in the aortic adventitia with collagen fibres passing through its interstices to form a strong composite neo-aorta without sacrificing the natural blood/endothelial interface and maintaining the natural support of the aortic valve within the sinuses of Valsalva. In this article we concentrate on the collaborations between disciplines which have allowed the development and further investigation of this method. All conclusions at this stage are tentative because the follow-up is not long enough to be fully confidant of the results. At present the best indication for PEARS is early in the progression of the root aneurysm when it offers conservation of the aortic valve and the blood/endothelial interface with the hope of indefinitely minimising the hazards of the aortic root. The clinical problem'The signature manifestation of cardiovascular pathology in MFS is a grossly dilated aortic root, which commonly results in aneurysm, aortic valve regurgitation, and an increased risk of dissection, rupture, and death; hence, the root is the source of all evil affecting patients with MFS' [1].This stark summary from one of the USA's leading surgeons specialising in aortic disease is a fair introduction to the problem.

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Effect of personalized external aortic root support on aortic root motion and distension in Marfan syndrome patients

Cited by 17 publications

References 34 publications

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Personalized external aortic root support: a review of the current status

An integrative approach to the Marfan aortic root between the patient, the physician and basic scientists: A case study in personalised external aortic root support (PEARS)

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