Abstract
BackgroundExternal wrapping is a surgical method performed to prevent the dilatation of the aorta and to decrease the risk of its dissection and rupture. However, it is also believed to cause degeneration of the aortic wall. A biomechanical analysis was thus performed to assess the stress of the aortic wall subjected to external wrapping.MethodsA stress analysis using the finite elements method was carried out on three models: a non-dilated aorta, a moderately dilated aorta and a wrapped aorta. The models were subjected to a pulsatile flow (120/80 mmHg) and a systolic aortic annulus motion of 11 mm.ResultsThe finite elements analysis showed that the stress exerted on the outer surface of the ascending aorta in the wrapping model (0.05–0.8 MPa) was similar to that observed in the normal aorta (0.03–0.7 MPa) and was lower than in the model of a moderately dilated aorta (0.06–1.4 MPa). The stress on the inner surface of the ascending aorta ranged from 0.2 MPa to 0.4 MPa in the model of the normal aorta, from 0.3 to 1.3 MPa in the model of the dilated aorta and from 0.05 MPa to 0.4 MPa in the wrapping model.ConclusionsThe results of this study suggest that the aortic wall is subjected to similar stress following a wrapping procedure to the one present in the normal aorta.
Highlights
External wrapping is a surgical method performed to prevent the dilatation of the aorta and to decrease the risk of its dissection and rupture
The highest values of stress in the aortic wall were observed at the end of the systole, when arterial pressure was at its peak and the heart muscle was completely contracted and maximally pulled the aortic annulus
The distribution of stress on the outer surface of the ascending aorta which was most similar to that observed in the normal aorta (0.03–0.7 MPa) was seen in the wrapping model (0.05–0.8 MPa)
Summary
External wrapping is a surgical method performed to prevent the dilatation of the aorta and to decrease the risk of its dissection and rupture. Some surgeons prefer the ”watch and wait” approach to a moderately dilated aorta accompanying aortic valve disease. This approach carries the risk of a reoperation in case of further aortic dilatation. Most cardiac surgeons choose to replace the dilated tubular part of the ascending aorta or perform other surgical procedures like aortoplasty or wrapping. In the 1970’s, Robicsek et al published the results of a theoretically less invasive surgical technique, called an aortoplasty [1]. It involved the removal or plication of the excessive aortic wall and the restoration of the normal aortic diameter.
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