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Multidisciplinary Histological and Mechanical Study of Aortic Aneurysm to Investigate Potential Parameters for Early Diagnosis of High Risk Rupture Pasquale.

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Presentation on theme: "Multidisciplinary Histological and Mechanical Study of Aortic Aneurysm to Investigate Potential Parameters for Early Diagnosis of High Risk Rupture Pasquale."— Presentation transcript:

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 Background P.Totaro AATS 2015 Seattle 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 Patients: 46 Samples:86 Materials and Methods 39 (85%) 46 (100%) A3 A2
AATS 2015 Seattle P.Totaro Materials and Methods Patients: Samples:86 46 (100%) 39 (85%) A3 A2 P2 A1 P1 IRCCS San Matteo,Pavia-Italy University of Pavia

7 Uniaxial Testing Device
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

8 Materials and Methods 1. Preconditioning 2. Failure Test
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 Number of Accepted Tests
AATS 2015 Seattle P.Totaro Number of Accepted Tests Overall Specimens: Accepted Test: 247 (62%) 163 (66%) Circumferential Longitudinal 71 (29%) 84 (34%) 32 (13%) Longitudinal Circumferential 92 (37%) 52 (21%) IRCCS San Matteo,Pavia-Italy University of Pavia

10 Preoperative TTE Evaluation
AATS 2015 Seattle P.Totaro Materials and Methods Preoperative Data Aortic Elasticity * Preoperative TTE Evaluation Histological Evaluation Age (> 60 yo) Gender Diameter (> 5cm) Indexed Diameter (>25) Bicuspid Valve Hypertension Aortic Insufficiency Aortic Distensibility (10-6cm2dyn-1) Aortic Stiffness Index Aortic Strein Elastolisis Mucoid Tissue Cystic Medionecrosis Disarrey * Ikonomidis et al, JACC 2004 Quantitative Score HATS (0-16) IRCCS San Matteo,Pavia-Italy University of Pavia

11 Materials and Methods Multi Step Analysis Comparison of all tests
AATS 2015 Seattle P.Totaro Materials and Methods Multi Step Analysis 1 Comparison of all tests Comparison of all tests - According each R/O configuration (AC,PC,AL,PL) 2 Selection of most frail samples (1 each configuration) - According each R/O configuration (AC,PC,AL,PL) 3 Selection of patients with complete test - According each R/O configuration (AC,PC,AL,PL) 4 IRCCS San Matteo,Pavia-Italy University of Pavia

12 Results - 1 P.Totaro Thickness/Position EM/Orientation
AATS 2015 Seattle P.Totaro Results - 1 Thickness/Position p<0,0001 Pstr/Orientation EM/Orientation p<0,0001 p<0,0001 IRCCS San Matteo,Pavia-Italy University of Pavia

13 Impact of preoperative parameters:
AATS 2015 Seattle Results - 1 P.Totaro PS Impact of preoperative parameters: Age >60 p<0,0001 Pstr p<0,0001 EM p<0,0001 IRCCS San Matteo,Pavia-Italy University of Pavia

14 Results - 2 P.Totaro AATS 2015 Seattle No significant differences
IRCCS San Matteo,Pavia-Italy University of Pavia

15 Results - 2 P.Totaro AATS 2015 Seattle No significant differences
IRCCS San Matteo,Pavia-Italy University of Pavia

16 ? Results - 2 Preoperative Risk Factors Analysis Age > 60 yo Gender
AATS 2015 Seattle P.Totaro Results - 2 Preoperative Risk Factors Analysis Age > 60 yo Gender Diameter > 5cm ID >25 Bicuspid Valve ? IRCCS San Matteo,Pavia-Italy University of Pavia

17 Results - 2 Preoperative Risk Factors Analysis Age > 60 yo Gender
AATS 2015 Seattle P.Totaro Results - 2 Preoperative Risk Factors Analysis P=0,027 Age > 60 yo Gender Diameter > 5cm ID >25 Bicuspid Valve IRCCS San Matteo,Pavia-Italy University of Pavia

18 Results - 2 P.Totaro AATS 2015 Seattle p= 0,0001 (AC,AL,PC)
p= NS (PL) p= NS (PC,PL) p= 0,001 (AC,AL) p= NS (PC,PL) IRCCS San Matteo,Pavia-Italy University of Pavia

19 Results - 2 Correlation to TTE Aortic Elasticity Evaluation P.Totaro
AATS 2015 Seattle P.Totaro Results - 2 Correlation to TTE Aortic Elasticity Evaluation p= 0,003 (AC,PC) p= 0,006 (AC) IRCCS San Matteo,Pavia-Italy University of Pavia

20 Results - 2 Correlation to Histological Evaluation P.Totaro AATS 2015
Seattle P.Totaro Results - 2 p=0,008 Correlation to Histological Evaluation p=0,0047 IRCCS San Matteo,Pavia-Italy University of Pavia

21 Results - 3 P.Totaro AATS 2015 Seattle IRCCS San Matteo,Pavia-Italy
University of Pavia

22 Results - 3 P.Totaro AATS 2015 Seattle P=0,02 (BV) P=0,04 (no BV)
IRCCS San Matteo,Pavia-Italy University of Pavia

23 Results - 3 Correlation to TTE Aortic Elasticity Evaluation P.Totaro
AATS 2015 Seattle P.Totaro Results - 3 Correlation to TTE Aortic Elasticity Evaluation P=0,0112 (F) P=0,0056 (no BV) IRCCS San Matteo,Pavia-Italy University of Pavia

24 Results - 3 Correlation to Histological Evaluation P.Totaro AATS 2015
Seattle P.Totaro Results - 3 Correlation to Histological Evaluation P=0,0129 P=0,045 (BV) IRCCS San Matteo,Pavia-Italy University of Pavia

25 Results - 3 Correlation to Histological Evaluation P.Totaro AATS 2015
Seattle P.Totaro Results - 3 Correlation to Histological Evaluation P=0,0129 P=0,0250 IRCCS San Matteo,Pavia-Italy University of Pavia

26 Results - 4 P.Totaro AATS 2015 Seattle p=0,0034
IRCCS San Matteo,Pavia-Italy University of Pavia

27 Results - 4 P.Totaro AATS 2015 Seattle p=0,0034 p<0,000001
IRCCS San Matteo,Pavia-Italy University of Pavia

28 Results - 4 P.Totaro AATS 2015 Seattle P<0,0001 p<0,000001
IRCCS San Matteo,Pavia-Italy University of Pavia

29 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 has to be defined with multiple evaluation Age is surely related to an impairment of mechanical properties IRCCS San Matteo,Pavia-Italy University of Pavia

30 AATS 2015 Seattle P.Totaro Conclusions - 2 The posterior region of the aorta seems to be more frail especially when a longitudinal force is applied regardless age of patients There are some correlations between increased maximum diameter and reduced strength of aortic wall There are some correlations between histological abnormalities and reduced strength of aortic wall IRCCS San Matteo,Pavia-Italy University of Pavia

31 AATS 2015 Seattle P.Totaro Conclusions - 3 There are clear correlations between histological abnormalities and maximum diameter Presence of bicuspid valve does not seem to impact significantly the mechanical properties of aortic wall IRCCS San Matteo,Pavia-Italy University of Pavia

32

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