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Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement.

Authors
  • Bollache, Emilie1
  • Fedak, Paul W M2
  • van Ooij, Pim3
  • Rahman, Ozair1
  • Malaisrie, S Chris4
  • McCarthy, Patrick M4
  • Carr, James C1
  • Powell, Alex1
  • Collins, Jeremy D1
  • Markl, Michael5
  • Barker, Alex J6
  • 1 Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
  • 2 Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, Ill. , (Canada)
  • 3 Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. , (Netherlands)
  • 4 Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, Ill.
  • 5 Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Ill.
  • 6 Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill. Electronic address: [email protected]
Type
Published Article
Journal
The Journal of thoracic and cardiovascular surgery
Publication Date
Jun 01, 2018
Volume
155
Issue
6
Identifiers
DOI: 10.1016/j.jtcvs.2017.11.007
PMID: 29248286
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To assess in patients with aortopathy perioperative changes in thoracic aortic wall shear stress (WSS), which is known to affect arterial remodeling, and the effects of specific surgical interventions. Presurgical and postsurgical aortic 4D flow MRI were performed in 33 patients with aortopathy (54 ± 14 years; 5 women; sinus of Valsalva (d_SOV)/midascending aortic (d_MAA) diameters = 44 ± 5/45 ± 6 mm) scheduled for aortic valve (AVR) and/or root (ARR) replacement. Control patients with aortopathy who did not have surgery were matched for age, sex, body size, and d_MAA (n = 20: 52 ± 14 years; 3 women; d_SOV/d_MAA = 42 ± 4/42 ± 4 mm). Regional aortic 3D systolic peak WSS was calculated. An atlas of WSS normal values was used to quantify the percentage of at-risk tissue area with abnormally high WSS, excluding the area to be resected/graft. Peak WSS and at-risk area showed low interobserver variability (≤0.09 [-0.3; 0.5] Pa and 1.1% [-7%; 9%], respectively). In control patients, WSS was stable over time (follow-up-baseline differences ≤0.02 Pa and 0.0%, respectively). Proximal aortic WSS decreased after AVR (n = 5; peak WSS difference ≤-0.41 Pa and at-risk area ≤-10%, P < .05 vs controls). WSS was increased after ARR in regions distal to the graft (peak WSS difference ≥0.16 Pa and at-risk area ≥4%, P < .05 vs AVR). Follow-up duration had no significant effects on these WSS changes, except when comparing ascending aortic peak WSS between ARR and AVR (P = .006). Serial perioperative 4D flow MRI investigations showed distinct patterns of postsurgical changes in aortic WSS, which included both reductions and translocations. Larger longitudinal studies are warranted to validate these findings with clinical outcomes and prediction of risk of future aortic events. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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