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 C. Carr, Alex Powell, Jeremy D. Collins, Michael Markl, Alex J. Barker*

*Corresponding author for this work

Research output: Contribution to journalArticle

16 Scopus citations

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 2018

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

Fingerprint Dive into the research topics of 'Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement'. Together they form a unique fingerprint.

  • Cite this