Wang Shuangjing, Jia Heyue, Xi Yifu, Yuan Pengfei, Wu Mingwei, Guo Wei, Chen Duanduan, Xiong Jiang
Department of Vascular and Endovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Emergency Surgery, Peking University People's Hospital, Beijing, China.
J Endovasc Ther. 2023 Sep 20:15266028231199930. doi: 10.1177/15266028231199930.
To explore the role of location, length, and thickness of the intimal flap in the propagation of Stanford type B aortic dissection (TBAD) based on ex vivo porcine aorta models based on ex vivo porcine aorta models.
The porcine aortas were harvested and randomly divided into 6 groups to create various TBAD aortic models. We constructed intimal flaps for different locations (group A [entry tear on outer curvature] and group B [entry tear on inner curvature]), lengths (group C [long] and group D [short]), and thicknesses (group E [thick] and group F [thin]). For the ex vivo perfusion experiments conducted on model aortas, an experimental circulation loop (ECL) was employed. The pressure in false lumen (FL) was constantly monitored. A comparison was made between the morphological data collected before and after the experiment to quantify the changes in the FL after the experiment.
Compared the results with group B, the mean peak pressures of the FL in group A were lower (106.87±15.55 vs. 124.01±22.75 mm Hg, p=0.028). The mean axial propagation length in group A was shown to be shorter than that of group B (88.14±33.38 vs. 197.43±41.65 mm, p<0.001). The mean peak pressure was higher in group C than in group D (144.04±19.37 vs. 92.51±26.70 mm Hg, p<0.001). The mean peak pressure of group E was higher than that of group F (160.83±32.83 vs. 109.33±15.62 mm Hg, p<0.001), as was the mean axial propagation length of group E (143.11±39.73 vs. 100.45±35.44 mm, p=0.021). According to the results of multivariable linear regression, axial propagation length=45.873-0.703×length of initial FL+0.863× peak pressure (p<0.001).
There was a relationship between FL propagation and the location, length, and thickness of the intimal flap. The axial propagation length was related to the length of the intimal flap and the peak pressure of propagation. It may be helpful to evaluate the risk of propagation in patients with TBAD.
This study found that the locations, lengths, and thickness of the intimal flap significantly contributed to propagation pressure of FL. Using dissection flap characteristics, a physician can predict FL development in a patient and formulate a treatment plan.The purpose was to investigate the relationship between the dissection flap characteristics (location, length, and thickness) and the propagation of the FL, which is not clear at present. This study employed porcine models to create an experimental circulation loop. The perfusion experiment was conducted using a FL without distal re-entry and a non-pulsating flow.
基于猪主动脉离体模型，探讨内膜瓣的位置、长度和厚度在B型主动脉夹层（TBAD）扩展中的作用。
获取猪主动脉并随机分为6组，以创建各种TBAD主动脉模型。我们构建了不同位置（A组[外曲面上的入口撕裂]和B组[内曲面上的入口撕裂]）、长度（C组[长]和D组[短]）和厚度（E组[厚]和F组[薄]）的内膜瓣。在模型主动脉上进行离体灌注实验时，采用了实验循环回路（ECL）。持续监测假腔（FL）内的压力。对实验前后收集的形态学数据进行比较，以量化实验后FL的变化。
与B组结果相比，A组FL的平均峰值压力较低（106.87±15.55对124.01±22.75 mmHg，p = 0.028）。A组的平均轴向扩展长度显示比B组短（88.14±33.38对197.43±41.65 mm，p<0.001）。C组的平均峰值压力高于D组（144.04±19.37对92.51±26.70 mmHg，p<0.001）。E组的平均峰值压力高于F组（160.83±32.83对109.33±15.62 mmHg，p<0.001），E组的平均轴向扩展长度也是如此（143.11±39.73对100.45±35.44 mm，p = 0.021）。根据多变量线性回归结果，轴向扩展长度=45.873 - 0.703×初始FL长度 + 0.863×峰值压力（p<0.001）。
FL扩展与内膜瓣的位置、长度和厚度之间存在关联。轴向扩展长度与内膜瓣长度和扩展峰值压力有关。这可能有助于评估TBAD患者的扩展风险。
本研究发现内膜瓣的位置、长度和厚度对FL的扩展压力有显著影响。利用夹层瓣特征，医生可以预测患者FL的发展并制定治疗方案。目的是研究夹层瓣特征（位置、长度和厚度）与FL扩展之间的关系，目前尚不清楚。本研究采用猪模型创建实验循环回路。灌注实验使用无远端再入口的FL和非脉动流进行。
