Hemodynamic predictors of negative false lumen remodeling after frozen elephant trunk for acute aortic dissection,General Thoracic and Cardiovascular Surgery

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Hemodynamic predictors of negative false lumen remodeling after frozen elephant trunk for acute aortic dissection
General Thoracic and Cardiovascular Surgery ( IF 1.1 ) Pub Date : 2023-11-10 , DOI: 10.1007/s11748-023-01984-x
Yusuke Takei ₁ , Shohei Miyazaki ₂ , Kohei Suzuki ₂ , Shunsuke Saito ₂ , Hayato Oogaki ₃ , Yuki Muraoka ₃ , Takeshi Ogasawara ₄ , Masahiro Tezuka ₁ , Ikuko Shibasaki ₁ , Hirotsugu Fukuda ₁

Affiliation

Objective

We evaluated the blood flow within the downstream aortic false lumen after frozen elephant trunk repair for acute aortic dissection and identified hemodynamic predictors of false lumen expansion and negative false lumen remodeling using four-dimensional flow magnetic resonance imaging.

Methods

Thirty-one patients (Stanford type A, n = 28; Stanford type B, n = 3) with patent false lumen who underwent frozen elephant trunk procedures for acute aortic dissection were included in this observational study. Each patient underwent computed tomography during the follow-up period and four-dimensional flow magnetic resonance imaging within 3 postoperative months. The false lumen volumetric expansion rate was calculated using computed tomography data. The direction and the rate of flow in the lower descending aortic false lumen were analyzed. Negative false lumen remodeling was defined as a volumetric increase of > 10% from the baseline volume.

Results

Negative false lumen remodeling had developed in 6 of the 31 patients during the observation period. Most of the false lumen flows were biphasic during systole. The range between peak and nadir flow rates was associated with the false lumen volumetric expansion rate (β coefficient = 6.77; p < 0.01, R² = 0.43).

Conclusions

The range between peak and nadir flow rates may serve as a hemodynamic predictor of negative false lumen remodeling, enabling further treatment for patients at risk of expansion in the downstream aorta.

中文翻译：

冷冻象鼻治疗急性主动脉夹层后负性假腔重塑的血流动力学预测因素

客观的

我们评估了急性主动脉夹层冷冻象鼻修复后下游主动脉假腔内的血流，并使用四维血流磁共振成像确定了假腔扩张和负假腔重塑的血流动力学预测因素。

方法

这项观察性研究纳入了 31 名患有明显假腔的患者（斯坦福 A 型， n = 28；斯坦福 B 型， n = 3），他们因急性主动脉夹层而接受了冷冻象鼻手术。每例患者在随访期间均接受计算机断层扫描，并在术后3个月内接受四维血流磁共振成像。使用计算机断层扫描数据计算假腔体积扩张率。分析了下降主动脉假腔中的血流方向和流速。负假腔重塑被定义为与基线体积相比体积增加> 10%。