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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 IRCCS San Matteo,Pavia-Italy University of Pavia Background Optimization of decision making process in patients presenting with ascending aorta aneurysm is still debated

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

4 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Background

5 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia 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

6 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Uniaxial Testing Device One or more test each Region/Orientation configuration Electromechanic Tension MTS Insight 10 kN (MTS System Corporation)

7 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Circumferential Longitudinal 163 (66%) 71 (29%) 92 (37%) Circumferential Longitudinal 84 (34%) 32 (13%) 52 (21%) Overall Specimens: 403 Accepted Test: 247 (62%) Patients: 46 Samples:86 A1 A2 A3 P1 P2

8 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Pstr = Peek Stress (Mpa) EM = Maximum Elastic Modulus (Mpa) PS = Peek Strein (mm/min) 1. Preconditioning2. Failure Test Materials and Methods

9 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Age (> 60 yo) Gender Diameter (> 5cm) Indexed Diameter (>25) Bicuspid Valve Hypertension Aortic Insufficiency Preoperative Data Aortic Elasticity * Preoperative TTE Evaluation Aortic Distensibility (10 -6 cm 2 dyn -1 ) Aortic Stiffness Index Aortic Strein Histological Evaluation Elastolisis Mucoid Tissue Cystic Medionecrosis Disarrey Materials and Methods * Ikonomidis et al, JACC 2004 Pulse Pressure (dyne)

10 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Age (> 60 yo) Gender Diameter (> 5cm) Indexed Diameter (>25) Bicuspid Valve Hypertension Aortic Insufficiency Preoperative Data Aortic Elasticity * Preoperative TTE Evaluation Aortic Distensibility (10 -6 cm 2 dyn -1 ) Aortic Stiffness Index Aortic Strein * Ikonomidis et al, JACC 2004 Histological Evaluation Elastolisis Mucoid Tissue Cystic Medionecrosis Disarrey Quantitative Score HATS (0-16) Materials and Methods Pulse Pressure (dyne)

11 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Results – 1 (247 tests) p<0,0001 Pstr/Orientation EM/Orientation

12 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia p<0,0001 PS Pstr EM Impact of preoperative parameters: Age >60 Results – 1 (247 tests)

13 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Results – 2 (247 tests) p<0,000001 No significant differences

14 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia p<0,000001 No significant differences Results – 2 (247 tests)

15 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Age > 60 yo Gender Diameter > 5cm ID >25 Bicuspid Valve ? Preoperative Risk Factors Analysis Results – 2 (247 tests)

16 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Age > 60 yo Gender Diameter > 5cm ID >25 Bicuspid Valve Preoperative Risk Factors Analysis P=0,027 Results – 2 (247 tests)

17 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia p= NS (PL) p= NS (PC,PL) p= 0,001 (AC,AL) p= NS (PC,PL) p= 0,001 (AC,AL) p= 0,0001 (AC,AL,PC) Results – 2 (247 tests)

18 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia p= 0,006 (AC) p= 0,003 (AC,PC) Correlation to TTE Aortic Elasticity Evaluation Results – 2 (247 tests)

19 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia p=0,008 p=0,0047 Correlation to Histological Evaluation Results – 2 (247 tests)

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

21 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Results – 3 (122 tests) P=0,02 (BV) P=0,04 (no BV)

22 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia P=0,0056 (no BV) P=0,0112 (F) Correlation to TTE Aortic Elasticity Evaluation Results – 3 (122 tests)

23 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia P=0,0129 P=0,045 (BV) Correlation to Histological Evaluation Results – 3 (122 tests)

24 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia P=0,0019 Correlation to Histological Evaluation Results – 3 (122 tests)

25 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia Results – 4 (52 tests) p=0,0034

26 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia p<0,000001 p=0,0034 Results – 4 (52 tests)

27 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia P<0,0001 p<0,000001 Results – 4 (52 tests)

28 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia 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

29 AATS 2015 Seattle P.Totaro IRCCS San Matteo,Pavia-Italy University of Pavia 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. Presence of bicuspid valve does not seem to impact significantly the mechanical properties of aortic wall Preoperative evaluation of aortic elasticity may help to identify patients with impaired mechanical properties

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