Validated Computational Model to Compute Re-apposition Pressures for Treating Type-B Aortic Dissections

Ahuja, Aashish; Guo, Xiaomei; Noblet, Jillian N.; Krieger, Joshua; Roeder, Blayne A.; Haulon, Stéphan; Chambers, Sean; Kassab, Ghassan S.

doi:10.3389/fphys.2018.00513

Cited by 7 publications

(8 citation statements)

References 40 publications

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“…The material parameters, C 10 , k 1 , k 2 , α, and κ , for all tissue specimens from different regions of the dissected aorta were presented in Tables 2 – 6 . These material parameters were used, as it is, for developing specimen-specific computational models for reproducing AD and analyzing the effects of therapy on the treatment of the disease (Ahuja et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…According to our results in Figure 5 , significant differences were not observed in circumferential stresses between mid and distal regions. This observation will be an important factor in sizing stents (Ahuja et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…The code used to compute material parameters was included as Supplementary Material , The estimated parameter values for the different regions of the dissected aortas were recorded in Tables 2 – 6 . The data in the tables were published in Ahuja et al ( 2018 ) and reused as part of current research.…”

Section: Methodsmentioning

confidence: 99%

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Biomechanical Material Characterization of Stanford Type-B Dissected Porcine Aortas

et al. 2018

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Aortic dissection (AD) involves tearing of the medial layer, creating a blood-filled channel called false lumen (FL). To treat dissections, clinicians are using endovascular therapy using stent grafts to seal the FL. This procedure has been successful in reducing mortality but has failed in completely re-attaching the torn intimal layer. The use of computational analysis can predict the radial forces needed to devise stents that can treat ADs. To quantify the hyperelastic material behavior for therapy development, we harvested FL wall, true lumen (TL) wall, and intimal flap from the middle and distal part of five dissected aortas. Planar biaxial testing using multiple stretch protocols were conducted on tissue samples to quantify their deformation behavior. A novel non-linear regression model was used to fit data against Holzapfel–Gasser–Ogden hyperelastic strain energy function. The fitting analysis correlated the behavior of the FL and TL walls and the intimal flap to the stiffness observed during tensile loading. It was hypothesized that there is a variability in the stresses generated during loading among tissue specimens derived from different regions of the dissected aorta and hence, one should use region-specific material models when simulating type-B AD. From the data on material behavior analysis, the variability in the tissue specimens harvested from pigs was tabulated using stress and coefficient of variation (CV). The material response curves also compared the changes in compliance observed in the FL wall, TL wall, and intimal flap for middle and distal regions of the dissection. It was observed that for small stretch ratios, all the tissue specimens behaved isotropically with overlapping stress–stretch curves in both circumferential and axial directions. As the stretch ratios increased, we observed that most tissue specimens displayed different structural behaviors in axial and circumferential directions. This observation was very apparent in tissue specimens from mid FL region, less apparent in mid TL, distal FL, and distal flap tissues and least noticeable in tissue specimens harvested from mid flap. Lastly, using mixed model ANOVAS, it was concluded that there were significant differences between mid and distal regions along axial direction which were absent in the circumferential direction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biomechanical Material Characterization of Stanford Type-B Dissected Porcine Aortas

et al. 2018

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“…Complicated TBAD is de ned by the presence of persistent or recurrent pain, uncontrolled hypertension despite medication treatment, aortic expansion, organ malperfusion, signs of a rupture, location of the intimal tear or retrograde dissection into the aortic arch [5,6]. The best medical treatment, open surgery, and endovascular treatment are three routine ways for the treatment of TBAD, while both thoracic endovascular aortic repair (TEVAR) and open surgery are recommended for complicated TBAD [7]. In recent decades, TEVAR has become the mainstream for treatment of complicated TBAD owing to its favorable short and mid-term results.…”

Section: Introductionmentioning

confidence: 99%

Open Stented Elephant Trunk for Complicated Stanford Type B Aortic Dissection: A Single-Center Experience

Tie

Kong

et al. 2020

Preprint

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Background: Open stented elephant trunk (SET) or SET with left subclavian artery to left common carotid artery bypass (LSCA-LCCA) is proven to a potentially alternative treatment for complex Stanford type B aortic dissection (TBAD). In the current study, we reported our experience with 10 consecutive patients who underwent open SET or with LSCA-LCCA bypass for patients.Methods: Patients with complicated TBAD underwent open SET for treatment from May 2016 to November 2018 in our institution were included. Patients’ clinical data were obtained from the electronic medical record system, and long-term clinical outcomes were collected by telephone interviews or outpatient interviews.Results: The average age of the 10 patients, including nine males and one female, was 47.3 (31–65) years. Increased D 2dimer and fibrinogen degradation products were observed in all patients at admission, and two patients had renal insufficiency. The average postoperative mechanical ventilation time, length of stay in intensive care unit and postoperative hospital length of stay were 46.9 (6.7-151.2) hours, 7.7 (4–17) days, and 15.7 (10–26) days. No postoperative death occurred. Acute kidney injury and other complications were observed, and they were all cured well when discharge. In long-term follow-up, computed tomography angiography indicated that aortas were completely well remodeled blood supply of the brachiocephalic trunks was normal without anastomotic complications, and all patients lived well.Conclusion: SET or SET with LSCA-LCCA bypass shows satisfactory clinical outcomes, and it could be considered as an alternative treatment. Well-designed, large-scale studies with long-term follow-up are still needed.

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“…Complicated TBAD is de ned by the presence of persistent or recurrent pain, uncontrolled hypertension despite medication treatment, aortic expansion, organ malperfusion, signs of a rupture, location of the intimal tear or retrograde dissection into aortic arch [5,6]. The best medical treatment, open surgery, and endovascular treatment are three routine ways to treatment TBAD, while both thoracic endovascular aortic repair (TEVAR) and open surgery are recommended for complicated TBAD [7]. In recent decades, TEVAR has become the mainstream for treatment of complicated TBAD owing to its favorable short and mid-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Open stented elephant trunk for complicated Stanford type B aortic dissection: a single-center experience

Kong

Zheng

et al. 2020

Preprint

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Background: Open stented elephant trunk (SET) or SET with left subclavian artery (LSCA) to left common carotid artery bypass (LCCA) is proven to a potentially alternative treatment for complicated Stanford type B aortic dissection (TBAD). In the current study, we reported our experience with ten consecutive TBAD patients who underwent open SET.Methods: Patients with complicated TBAD underwent open SET from May 2016 to November 2018 in our institution were included. Patients’ clinical data were obtained from the electronic medical record system, and long-term clinical outcomes were collected by telephone interviews or outpatient interviews.Results: A total of ten patients with nine males and one female were included, and the average age was 47.3 (31-65) years. Increased D-dimer and fibrinogen degradation products were observed in all patients at admission, and two patients had renal insufficiency. The average postoperative mechanical ventilation time, length of stay in intensive care unit, and postoperative hospital length of stay were 46.9 (6.7-151.2) hours, 7.7 (4-17) days, and 15.7 (10-26) days. No postoperative death occurred. Acute kidney injury and other complications were observed, and they were recovered well when discharge. In long-term follow-up, computed tomography angiography indicated that aortas were completely well remodeled, and blood supply of the brachiocephalic trunks was normal without anastomotic complications. All patients lived well. Conclusion: SET or SET with subclavian artery correction shows satisfactory clinical outcomes, and it could be considered as an alternative treatment. Well-designed, large-scale studies with long-term follow-up are still needed.

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Validated Computational Model to Compute Re-apposition Pressures for Treating Type-B Aortic Dissections

Cited by 7 publications

References 40 publications

Biomechanical Material Characterization of Stanford Type-B Dissected Porcine Aortas

Biomechanical Material Characterization of Stanford Type-B Dissected Porcine Aortas

Open Stented Elephant Trunk for Complicated Stanford Type B Aortic Dissection: A Single-Center Experience

Open stented elephant trunk for complicated Stanford type B aortic dissection: a single-center experience

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