To Explore the Effect of Preoperative Hemodynamic Factors on The Outcome of Pseudolumen After Stanford Type B Aortic Dissection TEVAR Based on Computer Fluid Dynamics

Authors

  • Xin He Department of Interventional, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • Lulu Peng Department of Interventional, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • CunWei Cheng Department of Interventional, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • Fangtao Zhu Department of Interventional, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • Weihua Huang Department of Interventional, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • Haibin Yu Department of Interventional, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China

DOI:

https://doi.org/10.1532/hsf.4737

Keywords:

Stanford type B aortic dissection, TEVAR, Computer fluid dynamics (CFD), Perioperative period, False cavity residue

Abstract

Objective: The preoperative aortic hemodynamic data of patients with Stanford type B aortic dissection were obtained by computer fluid dynamics (CFD). Then we explored the relationship between hemodynamic data and short-term residual pseudolumen after thoracic endovascular aortic repair (TEVAR) and predict the latter through the former.

Methods: We collected the relevant data of 53 patients who underwent TEVAR in our hospital. They were divided into the A group (residual false lumen group) and B group (closed false lumen group), according to whether there was a residual false cavity around the stent recently after TEVAR. Three-dimensional reconstruction and CFD analysis of the thoracic and abdominal aorta was performed by DSCTA before the operation to obtain the aortic wall shear stress (WSS) and maximum blood flow velocity of the true and false lumen at the entrance, middle point of the long axis, and distal decompression port at the peak time of ventricular systolic velocity. Through the statistical analysis, we further studied the predictive value of hemodynamic data for residual pseudolumen.

Results: There was no significant difference in age, male, preoperative and postoperative thoracic and abdominal aorta DSCTA interval, history of hypertension, history of diabetes, smoking, Pt and APTT at admission between the two groups (P > 0.05). The blood flow velocity and shear stress at the entrance of the false lumen and the distal decompression port in the two groups were statistically significant (P < 0.05), while the other hemodynamic indexes were not statistically significant (P > 0.05). Binary logistic regression analysis further showed that the shear stress of the false lumen at the level of the distal decompression port (OR = 1.73, P = 0.01) was an independent risk factor for the residual false lumen around the stent in the early stage after TEVAR. The ROC curve analysis showed that the AUC area of the ROC curve corresponding to the shear stress of the false cavity at the level of the distal decompression port was 0.83, the best cross-sectional value was 9.49pa, and the sensitivity and specificity were 84.60% and 72.50%.

Conclusions: The residual pseudolumen after TEVAR is related to the hemodynamic factors in the aorta before TEVAR. Preoperative hemodynamic data also have good predictive value. When the shear stress of the false lumen at the level of the distal decompression port is greater than 9.49pa, the probability of residual false lumen around the stent during the perioperative period significantly increases.

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Published

2022-07-07

How to Cite

He, X., Peng, L., Cheng, C., Zhu, F., Huang, W., & Yu, H. (2022). To Explore the Effect of Preoperative Hemodynamic Factors on The Outcome of Pseudolumen After Stanford Type B Aortic Dissection TEVAR Based on Computer Fluid Dynamics. The Heart Surgery Forum, 25(4), E483-E488. https://doi.org/10.1532/hsf.4737

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Articles