title: Detection of aortic wall instability with the new dissectometer: Correlation with histological findings.
abstract: OBJECTIVE
  Although risk stratification for aortic dissection or rupture based on aortic diameter is quite suboptimal, alternative methods for the assessment of the aortic wall stability are rare. We assessed the mechanical properties of the aortic wall by a new custom-made device mimicking transversal aortic wall shear stress during open heart surgery in comparison with histological examination.
  
  
  METHODS
  One-hundred and five aortic walls were tested by the 'dissectometer' (seven different measured and two calculated values) as well as histological examination was performed.
  
  
  RESULTS
  Histological examination classified the aortic wall as normal in 54 (51.4%) patients and pathologic in 51 (48.6%) patients. Six out of nine parameters assessed by the dissectometer showed a significant correlation to histological findings. Using ROC-analysis, the most reliable parameter (P9) showed a sensitivity of 93.3% and a specificity of 80.4% with an area under the curve of 0.89 when using a cut-off value of 3.4. In the logistic regression analysis, P9 was an independent predictor for aortic wall instability (OR 28.983, 95% CI 11.507-72.993, p < 0.0001).
  
  
  CONCLUSIONS
  The dissectometer is suitable for discriminating between stable and unstable aortic walls with a good correlation to histological examination holding promise for direct and quick intraoperative identification of aortic walls at risk for dissection.
authors.affiliation: Department of thoracic and cardiovascular surgery, West German Heart Center Essen, University hospital of Essen , Essen , Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarczyk
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Mareike
authors.initials: M
authors.lastname: Perrey
authors.forename: Hideo A
authors.initials: HA
authors.lastname: Baba
authors.forename: Vivien
authors.initials: V
authors.lastname: Price
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Benedik
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000601:surgery; D019719:Diagnostic Equipment; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D000066908:Simulation Training; D013718:Tensile Strength
keywords: Aortic dissection; cardiac surgery; dissectometer; histology