Diapositiva 1

1
Multidisciplinary Histological and Mechanical
Study of Aortic Aneurysm to Investigate Potential
Parameters for Early Diagnosis of High Risk
Rupture
Pasquale Totaro MD,PhD
Division of Cardiothoracic Surgery Center for
Genetic Cardiovascular Pathology IRCCS Foundation
Hospital San Matteo, PAVIA -Italy
Computational Mechanics, Department of
Engineering University of Pavia
2
AATS 2015 Seattle
P.Totaro
Background
Optimization of decision making process in
patients presenting with ascending aorta aneurysm
is still debated
IRCCS San Matteo,Pavia-Italy
University of Pavia
3
AATS 2015 Seattle
P.Totaro
Background
Optimization of decision making process in
patients presenting with ascending aorta aneurysm
is still debated
Despite several studies have been designed to
evaluate potential predictive risk factors for
early complications, maximum diameter still
remains the key criteria for surgical indication
IRCCS San Matteo,Pavia-Italy
University of Pavia
4
AATS 2015 Seattle
P.Totaro
Background
IRCCS San Matteo,Pavia-Italy
University of Pavia
5
AATS 2015 Seattle
P.Totaro
Objective
To investigate potential markers of early
complication in patients presenting with aortic
aneurysm we have analyzed the mechanical
characteristics of aortic wall and we have tried
to correlate these results to preoperative
parameters and histological intraoperative
evaluation
IRCCS San Matteo,Pavia-Italy
University of Pavia
6
AATS 2015 Seattle
P.Totaro
Uniaxial Testing Device


Electromechanic Tension MTS Insight 10 kN (MTS
System Corporation)
One or more test each Region/Orientation
configuration
IRCCS San Matteo,Pavia-Italy
University of Pavia
7
AATS 2015 Seattle
P.Totaro
Patients 46 Samples86
Overall Specimens 403 Accepted Test 247
(62)
84 (34)
32 (13)
163 (66)
71 (29)
Longitudinal
A3
A2
P2
A1
P1
Circumferential
92 (37)
52 (21)
IRCCS San Matteo,Pavia-Italy
University of Pavia
8
AATS 2015 Seattle
P.Totaro
Materials and Methods
1. Preconditioning
2. Failure Test

• Pstr Peek Stress (Mpa)
• EM Maximum Elastic Modulus (Mpa)
• PS Peek Strein (mm/min)

IRCCS San Matteo,Pavia-Italy
University of Pavia
9
AATS 2015 Seattle
P.Totaro
Materials and Methods
Preoperative Data
Aortic Elasticity Preoperative TTE Evaluation
Histological Evaluation
Age (gt 60 yo) Gender Diameter (gt
5cm) Indexed Diameter (gt25) Bicuspid
Valve Hypertension Aortic Insufficiency
Aortic Distensibility (10-6cm2dyn-1) Aortic
Stiffness Index Aortic Strein
Elastolisis Mucoid Tissue Cystic
Medionecrosis Disarrey
Pulse Pressure (dyne)
Ikonomidis et al, JACC 2004
IRCCS San Matteo,Pavia-Italy
University of Pavia
10
AATS 2015 Seattle
P.Totaro
Materials and Methods
Preoperative Data
Aortic Elasticity Preoperative TTE Evaluation
Histological Evaluation
Age (gt 60 yo) Gender Diameter (gt
5cm) Indexed Diameter (gt25) Bicuspid
Valve Hypertension Aortic Insufficiency
Aortic Distensibility (10-6cm2dyn-1) Aortic
Stiffness Index Aortic Strein
Elastolisis Mucoid Tissue Cystic
Medionecrosis Disarrey
Pulse Pressure (dyne)
Quantitative Score HATS (0-16)
Ikonomidis et al, JACC 2004
IRCCS San Matteo,Pavia-Italy
University of Pavia
11
AATS 2015 Seattle
P.Totaro
Results 1 (247 tests)
Pstr/Orientation
EM/Orientation
plt0,0001
plt0,0001
IRCCS San Matteo,Pavia-Italy
University of Pavia
12
AATS 2015 Seattle
P.Totaro
Results 1 (247 tests)
PS
Impact of preoperative parameters Age gt60
plt0,0001
Pstr
plt0,0001
EM
plt0,0001
IRCCS San Matteo,Pavia-Italy
University of Pavia
13
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
No significant differences
No significant differences
plt0,000001
plt0,000001
IRCCS San Matteo,Pavia-Italy
University of Pavia
14
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
No significant differences
No significant differences
plt0,000001
plt0,000001
IRCCS San Matteo,Pavia-Italy
University of Pavia
15
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
Preoperative Risk Factors Analysis
Age gt 60 yo Gender Diameter gt 5cm ID
gt25 Bicuspid Valve
?
IRCCS San Matteo,Pavia-Italy
University of Pavia
16
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
Preoperative Risk Factors Analysis
P0,027
Age gt 60 yo Gender Diameter gt 5cm ID
gt25 Bicuspid Valve
IRCCS San Matteo,Pavia-Italy
University of Pavia
17
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
p 0,0001 (AC,AL,PC)
p 0,001 (AC,AL)
p NS (PL)
p NS (PC,PL)
p 0,001 (AC,AL)
p NS (PC,PL)
IRCCS San Matteo,Pavia-Italy
University of Pavia
18
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
Correlation to TTE Aortic Elasticity Evaluation
p 0,003 (AC,PC)
p 0,006 (AC)
IRCCS San Matteo,Pavia-Italy
University of Pavia
19
AATS 2015 Seattle
P.Totaro
Results 2 (247 tests)
p0,008
Correlation to Histological Evaluation
p0,0047
IRCCS San Matteo,Pavia-Italy
University of Pavia
20
AATS 2015 Seattle
P.Totaro
Results - 3
IRCCS San Matteo,Pavia-Italy
University of Pavia
21
AATS 2015 Seattle
P.Totaro
Results 3 (122 tests)
P0,02 (BV)
P0,04 (no BV)
IRCCS San Matteo,Pavia-Italy
University of Pavia
22
AATS 2015 Seattle
P.Totaro
Results 3 (122 tests)
Correlation to TTE Aortic Elasticity Evaluation
P0,0112 (F)
P0,0056 (no BV)
IRCCS San Matteo,Pavia-Italy
University of Pavia
23
AATS 2015 Seattle
P.Totaro
Results 3 (122 tests)
Correlation to Histological Evaluation
P0,0129
P0,045 (BV)
IRCCS San Matteo,Pavia-Italy
University of Pavia
24
AATS 2015 Seattle
P.Totaro
Results 3 (122 tests)
Correlation to Histological Evaluation
P0,0019
IRCCS San Matteo,Pavia-Italy
University of Pavia
25
AATS 2015 Seattle
P.Totaro
Results 4 (52 tests)
p0,0034
IRCCS San Matteo,Pavia-Italy
University of Pavia
26
AATS 2015 Seattle
P.Totaro
Results 4 (52 tests)
plt0,000001
p0,0034
IRCCS San Matteo,Pavia-Italy
University of Pavia
27
AATS 2015 Seattle
P.Totaro
Results 4 (52 tests)
plt0,000001
Plt0,0001
IRCCS San Matteo,Pavia-Italy
University of Pavia
28
AATS 2015 Seattle
P.Totaro
Conclusions - 1
Mechanical characteristics of aortic wall do vary
according the region of the aorta and the force
applied.
Biomechanical characterization of aortic wall,
therefore, has to be defined only with multiple
tests from multiple specimens.
Age is surely related to an impairment of
mechanical properties
The posterior region of the aorta seems to be
more frail especially when a longitudinal force
is applied regardless age of patients
IRCCS San Matteo,Pavia-Italy
University of Pavia
29
AATS 2015 Seattle
P.Totaro
Conclusions - 2
There are significant correlations between
increased maximum diameter, histological
abnormalities and reduced strength of aortic
wall.
These correlations, however, do vary according
different regions of the aorta and the type of
force applied.
Preoperative evaluation of aortic elasticity may
help to identify patients with impaired
mechanical properties
Presence of bicuspid valve does not seem to
impact significantly the mechanical properties of
aortic wall
IRCCS San Matteo,Pavia-Italy
University of Pavia
30
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