Abstract
Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. However, a subset of these patients develops aortic rupture due to further dilatation of the residual dissected aorta. There is currently no reliable means to predict the risk of dilatation following TAAD repair. In this study, we performed a comprehensive morphological and hemodynamic analysis for patients with and without progressive aortic dilatation following surgical replacement of the ascending aorta. Patient-specific models of repaired TAAD were reconstructed from post-surgery computed tomography images for detailed computational fluid dynamic analysis. Geometric and hemodynamic parameters were evaluated and compared between patients with stable aortic diameters (N = 9) and those with aortic dilatation (N = 8). Our results showed that the number of re-entry tears and true/false lumen pressure difference were significantly different between the two groups. Patients with progressive aortic dilatation had higher luminal pressure difference (6.7 [4.6, 10.9] vs. 0.9 [0.5, 2.3] mmHg; P = 0.001) and fewer re-entry tears (1.5 [1, 2.8] vs. 5 [3.3, 7.5]; P = 0.02) compared to patients with stable aortic diameters, suggesting that these factors may serve as potential predictors of aneurysmal dilatation following surgical repair of TAAD.
Highlights
Type A aortic dissection (TAAD) involves the ascending aorta or the arch
Patient-specific computational fluid dynamics (CFD) simulations were performed in order to obtain flow patterns, time-averaged wall shear stress (TAWSS) and pressure throughout the repaired TAAD
We demonstrated that patients with progressive aortic dilatation following TAAD repair had significantly higher luminal pressure difference (6.7 [4.6, 10.9] mmHg) compared to the stable group (0.9 [0.5, 2.3] mmHg)
Summary
Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. We performed a comprehensive morphological and hemodynamic analysis for patients with and without progressive aortic dilatation following surgical replacement of the ascending aorta. Surgical repair of TAAD with replacement of the ascending aortic segment often leaves re-entry tears in the arch and descending aorta unattended, which may lead to late progressive aortic d ilatation[3]. Several anatomical studies of type B aortic dissection (TBAD) have reported potential associations between anatomical features of the dissected aorta and late adverse outcomes These include FL patency, larger aortic diameter, FL area, as well as the size and location of the entry tears[4,5,6,7,8,9]. Demonstrated global and regional hemodynamic differences between TBAD and repaired T AAD23, confirming the need for further understanding of flow in surgically repaired TAAD
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