Time-dependent mechanical behaviour of the aortic chronic dissection flap. (10th February 2022)

• Record Type: Journal Article
• Authors: Panpho, Phakakorn; Yang, Ying; Davies, Hannah A; Nawaytou, Omar; Harky, Amer; Torella, Francesco; Field, Mark; Madine, Jillian; Akhtar, Riaz
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 5(2022)
• Page Start: 892
• Page End: 901
• Publication Date: 2022-02-10
• Subjects: Chronic aortic dissection -- Dissection flap -- Biomechanics -- Biochemistry -- Time-dependent deformation -- False lumen; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivac029
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: The transition of aortic dissection from acute to chronic is poorly understood. We examined time-dependent mechanical behaviour and biochemical properties of chronic dissection tissues. METHODS: Aorta samples were obtained from 14 patients with mixed aetiology who were undergoing elective surgery for chronic dissected aneurysms, ranging from 3 months to 15 years post-dissection. The tissue elastic modulus and tissue deformation following application of loading for 5 h were measured for the false lumen (FL), true lumen (TL) and flap (FP) tissues with a custom-indentation technique. Collagen, elastin and glycosaminoglycan levels were determined with established biochemical assays. Elastin fragmentation was graded from histological sections. The number of tissues characterized was as follows: FP ( n = 10), TL ( n = 5 for biomechanical testing, n = 8 for biochemical analysis, n = 8 for histological assessment) and FL ( n = 4). RESULTS: Tissues stiffness was highest in FP [59.8 (14.8) kPa] as compared with TL [50.7 (6.2) kPa] and FL [40.5 (4.7) kPa] ( P = 0.023 and P = 0.006, respectively). FP [0.5 (0.08) mm] also exhibited reduced deformation relative to TL [0.7 (0.02) mm] and FL [0.9 (0.08) mm] ( P = 0.003 and P = 0.006, respectively), lowest collagen concentration [FP: 40.1 (19.6) µg/mg, TL: 59.9 (19.5) µg/mg, P = 0.008; FL: 79.1 (32.0) µg/mg, P = 0.006] and the lowest collagen: elastin ratio [0.4 (0.1)] relative to the other tissues [TL; 0.6 (0.3), P = 0.006, FL; 1.5 (0.4); P = 0.003]. Significant elastin loss was evident in the FL-stained tissue sections whereas highly aligned, long fibres were visible in the FP and TL. A linear relationship was found between the stiffness, deformation and the time from the dissection event to surgical intervention for the FP. All data are presented as median (interquartile range). CONCLUSIONS: FP exhibited reduced time-dependent deformation and distinct biochemical properties relative to TL and FL irrespective of connective tissue disorder or the anatomical region of the dissection. Abstract : Aortic dissection (AD) is characterized by the pathological formation of a new vascular lumen within the tunica media, and can be acute or chronic.