Age is superior to aortopathy phenotype as a predictor of aortic mechanics in patients with bicuspid valve.

Autor:	Thompson MA; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Kramer B; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Tarraf SA; Department of Bioengineering, College of Engineering, Northeastern University, Boston, Mass., Vianna E; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Gillespie C; Department of Biomedical Engineering, BioRobotics and Mechanical Testing Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio., Germano E; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Gentle B; Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio., Cikach F; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Lowry AM; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio., Pande A; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio., Blackstone E; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio., Hargrave J; Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio., Colbrunn R; Department of Biomedical Engineering, BioRobotics and Mechanical Testing Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio., Bellini C; Department of Bioengineering, College of Engineering, Northeastern University, Boston, Mass., Roselli EE; Department of Thoracic and Cardiovascular Surgery, Aortic Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: RosellE@ccf.org.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2023 Dec 26. Date of Electronic Publication: 2023 Dec 26.
DOI:	10.1016/j.jtcvs.2023.12.018
Abstrakt:	Objectives: Bicuspid aortic valve (BAV) aortopathy is defined by 3 phenotypes-root, ascending, and diffuse-based on region of maximal aortic dilation. We sought to determine the association between aortic mechanical behavior and aortopathy phenotype versus other clinical variables. Methods: From August 1, 2016, to March 1, 2023, 375 aortic specimens were collected from 105 patients undergoing elective ascending aortic aneurysm repair for BAV aortopathy. Planar biaxial data (191 specimens) informed constitutive descriptors of the arterial wall that were combined with in vivo geometry and hemodynamics to predict stiffness, stress, and energy density under physiologic loads. Uniaxial testing (184 specimens) evaluated failure stretch and failure Cauchy stress. Boosting regression was implemented to model the association between clinical variables and mechanical metrics. Results: There were no significant differences in mechanical metrics between the root phenotype (N = 33, 31%) and ascending/diffuse phenotypes (N = 72, 69%). Biaxial testing demonstrated older age was associated with increased circumferential stiffness, decreased stress, and decreased energy density. On uniaxial testing, longitudinally versus circumferentially oriented specimens failed at significantly lower Cauchy stress (50th [15th, 85th percentiles]: 1.0 [0.7, 1.6] MPa vs 1.9 [1.3, 3.1] MPa; P < .001). Age was associated with decreased failure stretch and stress. Elongated ascending aortas were also associated with decreased failure stress. Conclusions: Aortic mechanical function under physiologic and failure conditions in BAV aortopathy is robustly associated with age and poorly associated with aortopathy phenotype. Data suggesting that the root phenotype of BAV aortopathy portends worse outcomes are unlikely to be related to aberrant, phenotype-specific tissue mechanics. Competing Interests: Conflict of Interest Statement Dr Roselli discloses consulting relationships with Artivion, Cook Medical, W. L. Gore & Associates, Inc, Medtronic, and Terumo Aortic. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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