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. 2023 Nov 21:17:37-46.
doi: 10.1016/j.xjon.2023.10.035. eCollection 2024 Feb.

Type III aortic arch angulation increases aortic stiffness: Analysis from an ex vivo porcine model

Tim J Mandigers  1   2 , Ariel F Pascaner  3 , Michele Conti  3 , Martina Schembri  3 , Sonja Jelic  3 , Alessandra Favilli  4 , Daniele Bissacco  1 , Maurizio Domanin  1   5 , Joost A van Herwaarden  2 , Ferdinando Auricchio  3 , Santi Trimarchi  1   5
Affiliations

Type III aortic arch angulation increases aortic stiffness: Analysis from an ex vivo porcine model

Tim J Mandigers et al. JTCVS Open. .

Abstract

Objective: The relationship among increased aortic arch angulation, aortic flow dynamics, and vessel wall stiffness remains unclear. This experimental ex vivo study investigated how increased aortic arch angulation affects aortic stiffness and stent-graft induced aortic stiffening, assessed by pulse wave velocity (PWV).

Methods: Porcine thoracic aortas were connected to a circulatory mock loop in a Type I and Type III aortic arch configuration. Baseline characteristics and blood pressures were measured. Proximal and distal flow curves were acquired to calculate PWV in both arch configurations. After that, a thoracic stent-graft (VAMF2626C100TU) was deployed in aortas with adequate proximal landing zone diameters to reach 10% t0 20% oversizing. Acquisitions were repeated for both arch configurations after stent-graft deployment.

Results: Twenty-four aortas were harvested, surgically prepared, and mounted. Cardiac output was kept constant for both arch configurations (Type I: 4.74 ± 0.40 and Type III: 4.72 ± 0.38 L/minute; P = .703). Compared with a Type I arch, aortic PWV increased significantly in the Type III arch (3.53 ± 0.40 vs 3.83 ± 0.40 m/second; P < .001), as well as blood pressures. A stent-graft was deployed in 15 aortas. After deployment, Type I arch PWV increased (3.55 ± 0.39 vs 3.81 ± 0.44 m/second; P < .001) and Type III arch PWV increased although not significantly (3.86 ± 0.42 vs 4.03 ± 0.46 m/second; P = .094). Type III arch PWV resulted the highest and significantly higher compared with the Type I arch after stent-graft deployment (3.81 ± 0.44 vs 4.03 ± 0.46 m/second; P = .023).

Conclusions: Increased aortic arch angulation-as in a Type III arch-is associated with higher aortic PWV and blood pressures and this may negatively influence cardiovascular health.

Keywords: TEVAR; aortic flow dynamics; arch angulation; pulse wave velocity; type III aortic arch.

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Conflict of interest statement

Dr van Herwaarden is or has been a proctor or consultant for Gore Medical, Terumo Aortic, and Cook Medical. Dr Trimarchi is consultant and speaker for Medtronic Inc, WL Gore, and Terumo Aortic. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Graphical abstract
None
Thoracic porcine aortas in a Type I and Type III aortic arch configuration.
Figure 1
Figure 1
Schematic representation of the experimental setup and its components. 3D, Three dimensional.
Figure 2
Figure 2
Thoracic porcine aortas with a Type I and Type III aortic arch configuration, connected to the experimental setup.
Figure 3
Figure 3
Boxplots of the diastolic (A), systolic (B), and mean arterial blood pressures (C) in both arch configurations for the 24 thoracic aortic samples. Middle lines of the boxplots represent median values. Lower and upper border of the box represent the 25th and 75th percentile (interquartile range), respectively. Lower and upper whiskers represent the minimum and maximum values of nonoutliers, respectively. Points represent individual data points and positive or negative outliers. DBP, Diastolic blood pressure; SBP, systolic blood pressure; MAP, mean arterial pressure.
Figure 4
Figure 4
Boxplots of the aortic pulse wave velocity in both arch configurations for the 24 thoracic aortic samples. Middle lines of the boxplots represent median values. Lower and upper border of the box represent the 25th and 75th percentile (interquartile range), respectively. Lower and upper whiskers represent the minimum and maximum values of nonoutliers, respectively. Points represent individual data points and positive or negative outliers. PWV, Pulse wave velocity.
Figure 5
Figure 5
Boxplots of the aortic pulse wave velocity in both arch configurations before and after stent-graft deployment for 15 of the 24 thoracic aortic samples. Middle lines of the boxplots represent median values. Lower and upper border of the box represent the 25th and 75th percentile (interquartile range), respectively. Lower and upper whiskers represent the minimum and maximum values of nonoutliers, respectively. Points represent individual data points and positive or negative outliers. PWV, Pulse wave velocity.
Figure 6
Figure 6
Type III aortic arch angulation increases aortic stiffness. Middle lines of the boxplots represent median values. Lower and upper border of the box represent the 25th and 75th percentile (interquartile range), respectively. Lower and upper whiskers represent the minimum and maximum values of nonoutliers, respectively. Points represent individual data points and positive or negative outliers. PWV, Pulse wave velocity.
Figure E1
Figure E1
Illustration of operator-dependent manual placement of a minimum of 15 points between the proximal and distal connector to measure the centreline length of the aortic samples in Matlab (Mathworks).
See this image and copyright information in PMC

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