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

Emilie Bollache, Paul W.M. Fedak, Pim van Ooij, Ozair Rahman, S Chris Malaisrie, Patrick M McCarthy, James Carr, Alex Powell, Jeremy D Collins, Michael Markl, Alex J Barker*

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: To 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. Methods: Presurgical 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. Results: Peak 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 <.05 vs controls). WSS was increased after ARR in regions distal to the graft (peak WSS difference ≥0.16 Pa and at-risk area ≥4%, P <.05 vs AVR). Follow-up duration had no significant effects on these WSS changes, except when comparing ascending aortic peak WSS between ARR and AVR (P =.006). Conclusions: Serial 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.

Original languageEnglish (US)
Pages (from-to)2277-2286.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Aortic Valve
Thorax
Transplants
Sinus of Valsalva
Observer Variation
Atlases
Body Size
Thoracic Wall
Longitudinal Studies
Reference Values

Keywords

  • 4D flow MRI
  • aortic root replacement
  • aortic valve replacement
  • hemiarch repair
  • perioperative
  • wall shear stress

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{8e7a05cfd070450bbd7779149508f207,
title = "Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement",
abstract = "Objectives: To 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. Methods: Presurgical 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. Results: Peak 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 <.05 vs controls). WSS was increased after ARR in regions distal to the graft (peak WSS difference ≥0.16 Pa and at-risk area ≥4{\%}, P <.05 vs AVR). Follow-up duration had no significant effects on these WSS changes, except when comparing ascending aortic peak WSS between ARR and AVR (P =.006). Conclusions: Serial 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.",
keywords = "4D flow MRI, aortic root replacement, aortic valve replacement, hemiarch repair, perioperative, wall shear stress",
author = "Emilie Bollache and Fedak, {Paul W.M.} and {van Ooij}, Pim and Ozair Rahman and Malaisrie, {S Chris} and McCarthy, {Patrick M} and James Carr and Alex Powell and Collins, {Jeremy D} and Michael Markl and Barker, {Alex J}",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.jtcvs.2017.11.007",
language = "English (US)",
volume = "155",
pages = "2277--2286.e2",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement. / Bollache, Emilie; Fedak, Paul W.M.; van Ooij, Pim; Rahman, Ozair; Malaisrie, S Chris; McCarthy, Patrick M; Carr, James; Powell, Alex; Collins, Jeremy D; Markl, Michael; Barker, Alex J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 6, 01.06.2018, p. 2277-2286.e2.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement

AU - Bollache, Emilie

AU - Fedak, Paul W.M.

AU - van Ooij, Pim

AU - Rahman, Ozair

AU - Malaisrie, S Chris

AU - McCarthy, Patrick M

AU - Carr, James

AU - Powell, Alex

AU - Collins, Jeremy D

AU - Markl, Michael

AU - Barker, Alex J

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Objectives: To 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. Methods: Presurgical 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. Results: Peak 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 <.05 vs controls). WSS was increased after ARR in regions distal to the graft (peak WSS difference ≥0.16 Pa and at-risk area ≥4%, P <.05 vs AVR). Follow-up duration had no significant effects on these WSS changes, except when comparing ascending aortic peak WSS between ARR and AVR (P =.006). Conclusions: Serial 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.

AB - Objectives: To 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. Methods: Presurgical 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. Results: Peak 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 <.05 vs controls). WSS was increased after ARR in regions distal to the graft (peak WSS difference ≥0.16 Pa and at-risk area ≥4%, P <.05 vs AVR). Follow-up duration had no significant effects on these WSS changes, except when comparing ascending aortic peak WSS between ARR and AVR (P =.006). Conclusions: Serial 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.

KW - 4D flow MRI

KW - aortic root replacement

KW - aortic valve replacement

KW - hemiarch repair

KW - perioperative

KW - wall shear stress

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U2 - 10.1016/j.jtcvs.2017.11.007

DO - 10.1016/j.jtcvs.2017.11.007

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C2 - 29248286

AN - SCOPUS:85039057279

VL - 155

SP - 2277-2286.e2

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -