Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement

The Journal of Thoracic and Cardiovascular Surgery

Pim van Ooij¹  Ozair Rahman²  Emilie Bollache³  Paul W.M. Fedak⁴ 

[1] Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands;Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill;Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, Ill

关键词: wall shear stress;    aortic valve replacement;    aortic root replacement;    hemiarch repair;    perioperative;    4D flow MRI;   

DOI  :  10.1016/j.jtcvs.2017.11.007

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesTo assess in patients with aortopathy perioperative changes in thoracic aortic wall shear stress (WSS), which is known to affect arterial remodeling, and the effects of specific surgical interventions.MethodsPresurgical and postsurgical aortic 4D flow MRI were performed in 33 patients with aortopathy (54 ± 14 years; 5 women; sinus of Valsalva (d_SOV)/midascending aortic (d_MAA) diameters = 44 ± 5/45 ± 6 mm) scheduled for aortic valve (AVR) and/or root (ARR) replacement. Control patients with aortopathy who did not have surgery were matched for age, sex, body size, and d_MAA (n = 20: 52 ± 14 years; 3 women; d_SOV/d_MAA = 42 ± 4/42 ± 4 mm). Regional aortic 3D systolic peak WSS was calculated. An atlas of WSS normal values was used to quantify the percentage of at-risk tissue area with abnormally high WSS, excluding the area to be resected/graft.ResultsPeak WSS and at-risk area showed low interobserver variability (≤0.09 [−0.3; 0.5] Pa and 1.1% [−7%; 9%], respectively). In control patients, WSS was stable over time (follow-up–baseline differences ≤0.02 Pa and 0.0%, respectively). Proximal aortic WSS decreased after AVR (n = 5; peak WSS difference ≤−0.41 Pa and at-risk area ≤−10%, P P P = .006).ConclusionsSerial perioperative 4D flow MRI investigations showed distinct patterns of postsurgical changes in aortic WSS, which included both reductions and translocations. Larger longitudinal studies are warranted to validate these findings with clinical outcomes and prediction of risk of future aortic events.

【 授权许可】

Unknown