Type III aortic arch angulation increases aortic stiffness: Analysis from an ex vivo porcine modelCentral MessagePerspective
Tim J. Mandigers, MD,
Ariel F. Pascaner, PhD,
Michele Conti, PhD,
Martina Schembri, MS,
Sonja Jelic, BS,
Alessandra Favilli, DVM,
Daniele Bissacco, MD,
Maurizio Domanin, MD,
Joost A. van Herwaarden, MD, PhD,
Ferdinando Auricchio, PhD,
Santi Trimarchi, MD, PhD
Affiliations
Tim J. Mandigers, MD
Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands; Address for reprints: Tim J. Mandigers, MD, Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.
Ariel F. Pascaner, PhD
Civil Engineering and Architecture Department, Università degli Studi di Pavia, Pavia, Italy
Michele Conti, PhD
Civil Engineering and Architecture Department, Università degli Studi di Pavia, Pavia, Italy
Martina Schembri, MS
Civil Engineering and Architecture Department, Università degli Studi di Pavia, Pavia, Italy
Sonja Jelic, BS
Civil Engineering and Architecture Department, Università degli Studi di Pavia, Pavia, Italy
Alessandra Favilli, DVM
Veterinary and Food Safety of Animal Origin Department, ATS Pavia, Pavia, Italy
Daniele Bissacco, MD
Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
Maurizio Domanin, MD
Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
Joost A. van Herwaarden, MD, PhD
Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
Ferdinando Auricchio, PhD
Civil Engineering and Architecture Department, Università degli Studi di Pavia, Pavia, Italy
Santi Trimarchi, MD, PhD
Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
Objective: The relationship among increased aortic arch angulation, aortic flow dynamics, and vessel wall stiffness remains unclear. This experimental ex vivo study investigated how increased aortic arch angulation affects aortic stiffness and stent-graft induced aortic stiffening, assessed by pulse wave velocity (PWV). Methods: Porcine thoracic aortas were connected to a circulatory mock loop in a Type I and Type III aortic arch configuration. Baseline characteristics and blood pressures were measured. Proximal and distal flow curves were acquired to calculate PWV in both arch configurations. After that, a thoracic stent-graft (VAMF2626C100TU) was deployed in aortas with adequate proximal landing zone diameters to reach 10% t0 20% oversizing. Acquisitions were repeated for both arch configurations after stent-graft deployment. Results: Twenty-four aortas were harvested, surgically prepared, and mounted. Cardiac output was kept constant for both arch configurations (Type I: 4.74 ± 0.40 and Type III: 4.72 ± 0.38 L/minute; P = .703). Compared with a Type I arch, aortic PWV increased significantly in the Type III arch (3.53 ± 0.40 vs 3.83 ± 0.40 m/second; P < .001), as well as blood pressures. A stent-graft was deployed in 15 aortas. After deployment, Type I arch PWV increased (3.55 ± 0.39 vs 3.81 ± 0.44 m/second; P < .001) and Type III arch PWV increased although not significantly (3.86 ± 0.42 vs 4.03 ± 0.46 m/second; P = .094). Type III arch PWV resulted the highest and significantly higher compared with the Type I arch after stent-graft deployment (3.81 ± 0.44 vs 4.03 ± 0.46 m/second; P = .023). Conclusions: Increased aortic arch angulation—as in a Type III arch—is associated with higher aortic PWV and blood pressures and this may negatively influence cardiovascular health.
