Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study
Thoracic endovascular aortic repair (TEVAR) has been widely adopted as a standard for treating complicated acute and high-risk uncomplicated Stanford Type-B aortic dissections. The treatment redirects the blood flow towards the true lumen by covering the proximal dissection tear which promotes seali...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Bioengineering and Biotechnology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2024.1326190/full |
| _version_ | 1797236944194764800 |
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| author | Aashish Ahuja Xiaomei Guo Jillian N. Noblet Joshua F. Krieger Blayne Roeder Stéphan Haulon Sean Chambers Ghassan Kassab |
| author_facet | Aashish Ahuja Xiaomei Guo Jillian N. Noblet Joshua F. Krieger Blayne Roeder Stéphan Haulon Sean Chambers Ghassan Kassab |
| author_sort | Aashish Ahuja |
| collection | DOAJ |
| description | Thoracic endovascular aortic repair (TEVAR) has been widely adopted as a standard for treating complicated acute and high-risk uncomplicated Stanford Type-B aortic dissections. The treatment redirects the blood flow towards the true lumen by covering the proximal dissection tear which promotes sealing of the false lumen. Despite advances in TEVAR, over 30% of Type-B dissection patients require additional interventions. This is primarily due to the presence of a persistent patent false lumen post-TEVAR that could potentially enlarge over time. We propose a novel technique, called slit fenestration pattern creation, which reduces the forces for re-apposition of the dissection flap (i.e., increase the compliance of the flap). We compute the optimal slit fenestration design using a virtual design of experiment (DOE) and demonstrate its effectiveness in reducing the re-apposition forces through computational simulations and benchtop experiments using porcine aortas. The findings suggest this potential therapy can drastically reduce the radial loading required to re-appose a dissected flap against the aortic wall to ensure reconstitution of the aortic wall (remodeling). |
| first_indexed | 2024-04-24T17:11:54Z |
| format | Article |
| id | doaj.art-acb6886c1d2d4157b8c3d7b97b2078ea |
| institution | Directory Open Access Journal |
| issn | 2296-4185 |
| language | English |
| last_indexed | 2024-04-24T17:11:54Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj.art-acb6886c1d2d4157b8c3d7b97b2078ea2024-03-28T09:36:05ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852024-03-011210.3389/fbioe.2024.13261901326190Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench studyAashish Ahuja0Xiaomei Guo1Jillian N. Noblet2Joshua F. Krieger3Blayne Roeder4Stéphan Haulon5Sean Chambers6Ghassan Kassab7California Medical Innovations Institute, San Diego, CA, United StatesCalifornia Medical Innovations Institute, San Diego, CA, United StatesCook Medical, Bloomington, IN, United StatesCook Medical, Bloomington, IN, United StatesCook Medical, Bloomington, IN, United StatesChirurgie Vasculaire—Centre de l’Aorte, Hôpital Marie Lannelongue, Université Paris Saclay, Paris, FranceCook Medical, Bloomington, IN, United StatesCalifornia Medical Innovations Institute, San Diego, CA, United StatesThoracic endovascular aortic repair (TEVAR) has been widely adopted as a standard for treating complicated acute and high-risk uncomplicated Stanford Type-B aortic dissections. The treatment redirects the blood flow towards the true lumen by covering the proximal dissection tear which promotes sealing of the false lumen. Despite advances in TEVAR, over 30% of Type-B dissection patients require additional interventions. This is primarily due to the presence of a persistent patent false lumen post-TEVAR that could potentially enlarge over time. We propose a novel technique, called slit fenestration pattern creation, which reduces the forces for re-apposition of the dissection flap (i.e., increase the compliance of the flap). We compute the optimal slit fenestration design using a virtual design of experiment (DOE) and demonstrate its effectiveness in reducing the re-apposition forces through computational simulations and benchtop experiments using porcine aortas. The findings suggest this potential therapy can drastically reduce the radial loading required to re-appose a dissected flap against the aortic wall to ensure reconstitution of the aortic wall (remodeling).https://www.frontiersin.org/articles/10.3389/fbioe.2024.1326190/fullaortic dissectionslit fenestration therapysimulationFEAstent graftacute dissection |
| spellingShingle | Aashish Ahuja Xiaomei Guo Jillian N. Noblet Joshua F. Krieger Blayne Roeder Stéphan Haulon Sean Chambers Ghassan Kassab Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study Frontiers in Bioengineering and Biotechnology aortic dissection slit fenestration therapy simulation FEA stent graft acute dissection |
| title | Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study |
| title_full | Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study |
| title_fullStr | Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study |
| title_full_unstemmed | Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study |
| title_short | Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study |
| title_sort | dissection flap fenestration can reduce re apposition force of the false lumen in type b aortic dissection a computational and bench study |
| topic | aortic dissection slit fenestration therapy simulation FEA stent graft acute dissection |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2024.1326190/full |
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