Wall stresses of early remodeled pulmonary autografts.
Wall stresses of early remodeled pulmonary autografts.
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DOI：
10.1016/j.jtcvs.2021.08.058
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发表时间：
2022-12
期刊：
影响因子：
--
通讯作者：
Tseng EE
中科院分区：
文献类型：
--
作者：
Xuan Y;Alonso E;Emmott A;Wang Z;Kumar S;Mongeon FP;Leask RL;El-Hamamsy I;Ge L;Tseng EE
Ross手术对于需要主动脉瓣置换的儿童或年轻成人是一个很好的选择，因为它可以恢复正常年龄匹配人群的生存率。然而，自体移植物重塑可能导致血管瘤形成和再次手术，并且该过程的生物力学尚不清楚。本研究通过检查患者特异性自体移植物壁应力来研究Ross手术后的自体移植物重塑。招募了具有术中肺根和主动脉标本的Ross手术患者。在1年随访时，使用来自电影磁共振成像（MRI）的患者特定材料特性及其相应几何形状开发患者特定模型（n=16）。重建用于动脉瘤修复的自体移植物± Dacron和升主动脉几何形状，以开发患者特定的有限元模型，该模型结合了材料特性和双轴拉伸实验测量的壁厚。使用乘法方法解释体内MRI的预应力几何形状。使用LS-DYNA软件进行压力加载至体循环压力（120/80）。在收缩期，自体移植窦管连接处（STJ）、窦、瓣环和升主动脉的第一主应力分别为809 kPa（25-75% IQR，691- 1219 kPa）、567 kPa（485- 675 kPa）、637 kPa（555- 755 kPa）和382 kPa（334- 413 kPa）。自体移植物STJ、窦、瓣环和升主动脉的第二主应力分别为360 kPa（310- 426 kPa）、355 kPa（320- 394 kPa）、272 kPa（252- 319 kPa）和184 kPa（147- 222 kPa）。STJ、窦和瓣环处的平均自体移植物直径分别为29.9± 2.7 mm、38.3± 5.3 mm和26.6± 4.0 mm。第一主应力峰值主要位于STJ，特别是当使用涤纶加强。在了解长期随访期间的生物力学行为后，患者特定模拟为预测未来自体移植物扩张奠定了基础。
Ross procedure is an excellent option for children or young adults who need aortic valve replacement because it can restore survival to normal aged-matched population. However, autograft remodeling can lead to aneurysmal formation and reoperation, and the biomechanics of this process is unknown. This study investigated postoperative autograft remodeling after Ross procedure by examining patient-specific autograft wall stresses. Ross procedure patients who had intraoperative pulmonary root and aortic specimens collected were recruited. Patient-specific models (n=16) were developed using patient-specific material property and their corresponding geometry from cine magnetic resonance imaging (MRI) at one-year follow-up. Autograft ± Dacron for aneurysm repair and ascending aortic geometries were reconstructed to develop patient-specific finite element models, which incorporated material properties and wall thickness experimentally measured from biaxial stretching. Multiplicative approach was used to account for pre-stress geometry from in-vivo MRI. Pressure loading to systemic pressure (120/80) was performed using LS-DYNA software. At systole, first principal stresses were 809kPa (25-75% IQR, 691-1219kPa), 567kPa (485-675kPa), 637kPa (555-755kPa), and 382kPa (334-413kPa) at autograft sinotubular junction (STJ), sinuses, annulus, and ascending aorta, respectively. Second principal stresses were 360kPa (310-426kPa), 355kPa (320-394kPa), 272kPa (252-319kPa), and 184kPa (147-222kPa) at autograft STJ, sinuses, annulus, and ascending aorta, respectively. Mean autograft diameters were 29.9±2.7mm, 38.3±5.3mm, and 26.6±4.0mm at STJ, sinuses, and annulus, respectively. Peak first principal stresses were mainly located at STJ, particularly when Dacron reinforcement was used. Patient-specific simulations lay the foundation for predicting autograft dilatation in the future after understanding biomechanical behavior during long-term follow-up.
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影响因子：
37.8
作者：
Charitos, Efstratios I.;Hanke, Thorsten;Sievers, Hans H.
通讯作者：
Sievers, Hans H.
影响因子：
4.6
作者：
Skillington, Peter D.;Mokhles, M. Mostafa;Tatoulis, James
通讯作者：
Tatoulis, James
影响因子：
168.9
作者：
El-Hamamsy, Ismail;Eryigit, Zeynep;Yacoub, Magdi H.
通讯作者：
Yacoub, Magdi H.
DOI：
10.1016/s0022-5223(97)70223-x
发表时间：
1997-04-01
影响因子：
6
作者：
Hokken, RB;Bogers, AJJC;Bos, E
通讯作者：
Bos, E
影响因子：
37.8
作者：
Sievers, HH;Dahmen, G;Schmidtke, C
通讯作者：
Schmidtke, C