title: Total aortic arch replacement: superior ventriculo-arterial coupling with decellularized allografts compared with conventional prostheses.
abstract: BACKGROUND
  To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts.
  
  
  METHODS
  After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group). Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees), arterial elastance (Ea) and ventriculoarterial coupling were calculated. Characteristic impedance (Z) was assessed by Fourier analysis.
  
  
  RESULTS
  While Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL), Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05) in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL). This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%). Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3 dyn·sec·cm(-5) vs. 32.4±2.0 dyn·sec·cm(-5), P<0.05).
  
  
  CONCLUSIONS
  Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving ventriculoarterial mechanoenergetics after aortic arch replacement.
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Alexander
authors: A
authors: Weymann
authors: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: Tamás
authors: T
authors: Radovits
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Bastian
authors: B
authors: Schmack
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Sevil
authors: S
authors: Korkmaz
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Shiliang
authors: S
authors: Li
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Nicole
authors: N
authors: Chaimow
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Ines
authors: I
authors: Pätzold
authors: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors: Peter Moritz
authors: PM
authors: Becher
authors: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: István
authors: I
authors: Hartyánszky
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: Pál
authors: P
authors: Soós
authors: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: Gergő
authors: G
authors: Merkely
authors: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: Balázs Tamás
authors: BT
authors: Németh
authors: 2nd Department of Pathology, Semmelweis University, Budapest, Hungary.
authors: Roland
authors: R
authors: Istók
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: Gábor
authors: G
authors: Veres
authors: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors: Béla
authors: B
authors: Merkely
authors: Federal Environment Agency, Dessau-Roβlau, Germany; Department of Earth Science, Free University Berlin, Berlin, Germany.
authors: Konstantin
authors: K
authors: Terytze
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Matthias
authors: M
authors: Karck
authors: Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.
authors: Gábor
authors: G
authors: Szabó
mesh_terms: D064591:Allografts; D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery / Q000637:transplantation*; D001018:Aortic Diseases / Q000503:physiopathology / Q000601:surgery; D001696:Biomechanical Phenomena; D001807:Blood Vessel Prosthesis; D004285:Dogs; D005260:Female; D008297:Male; D009200:Myocardial Contraction; D014655:Vascular Resistance; D017725:Ventricular Pressure