Abstract
Elastic extra-aortic wrapping is a potential non-pharmacological way to improve aortic compliance and treat isolated systolic hypertension associated with a stiffened aorta. We aimed to use computer simulations to re-evaluate whether there is aortic shape distortion in aortic wrapping to achieve greater elasticity of the wrapped aortic segment. Non-linear transient numerical analysis based on an idealized hyper-elastic single-layered aorta model was performed to simulate the force/displacement regimes of external aortic wrapping. Pressure-displacement relationships were used to establish model aortic wall distensibilities of 4.3 and 5.5 (10−3 mmHg−1). A physiological pulsatile lumen pressure was employed to estimate the potential improvements in aortic distensibility by compression forces representing elastic aortic wrapping. In the less distensible model of the aortic wall there was increased systolic expansion in the wrapped segment. We found a risk of creasing of the aortic luminal wall with wrapping. Sufficient unloading of a thick and elastic aortic wall to induce increased compliance, as observed in elastic wrapping, is associated with the potential risk of over compression and folding (creasing) inside the lumen.
Highlights
Reduced aortic distensibility results in high pulse pressure, which is further augmented by wave reflection [1]
Iliopoulos [3] reports in vivo ovine experiments in which the aortic wrapping procedure was applied to the proximal descending thoracic aorta which showed no improvement in pulse pressure, and there was a notable increase in aortic stiffness
ConTchluespiorenssented investigation shows that high compression forces in elastic extra-aortic wrapping could lead to folding of the aortic wall, which could increase turbulent blood flow and the risk for embTohliecperveesnetnst.eWd eindveemstoignasttiroanteshthoawt sthtehaetffheicgtihvictoymopf raensseixotnraf-oarocretsicinwerlaapstiiscdeexptrean-daoerntticown rthape paionrgtic cosutilfdfnleesasd, atso afofludninctgioonf tohfemaaotretriciawl parllo,pwehrtiicehs,cwoualldl tihniccrkenaessest,uarnbduldeinatmbeloteord
Summary
Improving the distensibility of the aorta may be achieved by an elastic extra-aortic wrap Such a wrapping of the external surface of the aorta reduces its diameter transiently during pulsatile flow. In experimental models such an extra-aortic wrap has been shown to reduce both systolic blood pressure and pulse pressure [3]. Iliopoulos [3] reports in vivo ovine experiments in which the aortic wrapping procedure was applied to the proximal descending thoracic aorta which showed no improvement in pulse pressure, and there was a notable increase in aortic stiffness We suggest this is of little surprise as the investigated aorta was of a young sheep and, had a high compliance. The aims were to use computer simulations to re-evaluate whether there is aortic shape distortion in aortic wrapping to achieve greater elasticity of the wrapped aortic segment
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