title: Early distal remodeling after elephant trunk repair of thoraco-abdominal aortic aneurysms.
abstract: Hemodynamic alterations occur when the elephant trunk (ET) technique is adopted to treat extensive aortic aneurysms. In planning the 2nd stage operation to complete ET repair, surgeons must weigh an adequate recovery time after initial surgery against the risk of postoperative ET-related complications. The purpose of this study was to understand the mechanistic link between the flow alteration caused by the ET graft and the development of premature aortic rupture before the 2nd stage operation. Specifically, fluid-structure interaction (FSI) analysis was performed using the CT imaging data of aorta at different stages of ET repair, and then computational variables were compared to those observed in patients who underwent a prophylactic 2nd stage operation to complete aortic repair. Results show that intramural stress exerted near the distal ET anastomosis (IMS=37.5kPa) at the time of urgent intervention was comparable to that of the extensive aortic aneurysm (IMS=47.4kPa) at initial in-hospital admission, but was considerably higher than that occurring after the 1st stage procedure (IMS=3.5kPa). Pressure index suggested higher peri-graft pressurization than aortic lumen pressure during diastole, imparting an apparent risk of aortic dilatation. These critical hemodynamic and structural parameters are related to the impending rupture of descending aorta observed clinically and can thus guide prophylactic intervention and optimal timing for the 2nd stage operation of a ET technique.
authors.affiliation: Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy. Electronic address: graffa@ismett.edu.
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Raffa
authors.affiliation: Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy; Fondazione Ri.MED, Palermo, Italy. Electronic address: spasta@fondazionerimed.com.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pasta
authors.affiliation: Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gentile
authors.affiliation: Department of Chemical, Management, Computer Science, Mechanical Engineering, University of Palermo, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Scardulla
authors.affiliation: School of Medicine, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Wu
authors.affiliation: Cardiovascular Medicine Clinical and Research Unit, Vivantes Klinikum im Friedrichschein und Am Urban, Berlin, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.affiliation: Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Follis
authors.affiliation: Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT-IRCCS), Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pilato
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008954:Models, Biological; D011183:Postoperative Complications / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000009:adverse effects
keywords: Aortic aneurysm; Elephant trunk technique; Fluid-structure interaction analysis; TEVAR