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. 2024 Mar 28:12:1326190.
doi: 10.3389/fbioe.2024.1326190. eCollection 2024.

Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study

Aashish Ahuja  1 , Xiaomei Guo  1 , Jillian N Noblet  2 , Joshua F Krieger  2 , Blayne Roeder  2 , Stéphan Haulon  3 , Sean Chambers  2 , Ghassan Kassab  1
Affiliations

Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study

Aashish Ahuja et al. Front Bioeng Biotechnol. .

Abstract

Thoracic endovascular aortic repair (TEVAR) has been widely adopted as a standard for treating complicated acute and high-risk uncomplicated Stanford Type-B aortic dissections. The treatment redirects the blood flow towards the true lumen by covering the proximal dissection tear which promotes sealing of the false lumen. Despite advances in TEVAR, over 30% of Type-B dissection patients require additional interventions. This is primarily due to the presence of a persistent patent false lumen post-TEVAR that could potentially enlarge over time. We propose a novel technique, called slit fenestration pattern creation, which reduces the forces for re-apposition of the dissection flap (i.e., increase the compliance of the flap). We compute the optimal slit fenestration design using a virtual design of experiment (DOE) and demonstrate its effectiveness in reducing the re-apposition forces through computational simulations and benchtop experiments using porcine aortas. The findings suggest this potential therapy can drastically reduce the radial loading required to re-appose a dissected flap against the aortic wall to ensure reconstitution of the aortic wall (remodeling).

Keywords: FEA; acute dissection; aortic dissection; bench validation; simulation; slit fenestration therapy; stent graft; type-B dissection.

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Conflict of interest statement

Authors JN, JK, BR and SC were employed by the company Cook Medical. SH has intellectual property and is a consultant for Cook Medical. Author GK has received funding for this project from CookMedical and is the founder of 3DT Holdings. The funder had the following involvement in the study: study design, data collection and analysis, decision to publish, or preparation of the manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) CAD geometry of a dissected aorta and the rigid expansion member used to re-appose the flap against the FL wall. Adapted from (Ahuja et al., 2018a) (B) Schematic of the benchtop setup used to record re-apposition pressure. A dissected porcine aorta was pressurized at static pressure, and a balloon was placed within the TL and inflated to re-appose the flap against the FL wall (C) Inverted and Dissected Aortas with the optimal slit fenestration pattern. The proximal and distal sections of the aorta are mentioned, which are also areas of interest for bench tests and simulations.
FIGURE 2
FIGURE 2
(A) Transverse ultrasound image of the baseline aorta suspended in the benchtop setup (B) An aorta flap fenestrated with optimal slit fenestration pattern is re-apposed using a balloon.
FIGURE 3
FIGURE 3
(A) Different slit fenestration patterns and the (B) average circumferential stresses generated during re-apposition simulations.
FIGURE 4
FIGURE 4
(A) The optimal slit fenestration pattern lowers the peak circumferential stresses generated in the flap during re-apposition (B) Average circumferential stress reduction in TL wall, flap, and FL wall during the re-apposition process for the non-fenestrated baseline case and in the presence of slit fenestration Pattern D.
FIGURE 5
FIGURE 5
Resulting diameters of the (A) proximal and (B) distal sections of the dissected aorta on complete re-apposition of the intimal flap in the presence and absence of slit fenestration.
FIGURE 6
FIGURE 6
(A) The re-apposition pressures required for baseline dissected aorta over the range of static aortic pressures (B) Re-apposition pressures for slit fenestrated aortas under different static aortic pressures. Average and standard errors for re-apposition pressures observed for baseline and slit-fenestrated flaps tested in (C) proximal and (D) distal regions.
FIGURE 7
FIGURE 7
Benchtop and computational re-apposition pressures are required to re-appose (A) proximal and (B) distal flap sections against the FL wall. The re-apposition pressures are significantly reduced in the presence of slit fenestration.
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