INTRODUCTION: False aneurysms in the thoracic aorta are dangerous complications that can occur after cardiac surgery. They often result in high mortality rates. These aneurysms are caused by damage to all layers of the aortic wall. This study aimed to pinpoint the area of the experimental specimen (native vessel, anastomosis, or prosthetic graft) with the greatest deformation, to determine whether a false aneurysm is likely to develop in the anastomotic portion. METHODS: We conducted the inflation-extension test by performing eight cycles ranging from 0 to 20. The pressure sampling frequency was 100 Hz, and each cycle lasted approximately 34 seconds, resulting in a loading frequency of 0.03 Hz. During the experiment, each camera captured 3,000 frames. Based on the data collected, we evaluated and compared the loading stages of cycle 1 and cycle 8. RESULTS AND DISCUSSION: During loading, the native vessel experienced a dominant deformation of approximately 7% in the circumferential direction. The prosthetic graft, which had a longitudinal construction, deformed by approximately 8% in the axial direction. The prosthetic graft, on the other hand, only experienced a deformation of up to 1.5% in the circumferential direction, which was about 5 times smaller than the deformation of the native vessel. The anastomosis area was very stiff and showed minimal deformation. Additionally, there was little difference in the mechanical response between the first C1 and the eighth C8 cycle. CONCLUSION: Based on the available evidence, it can be inferred that aortic false aneurysms are more likely to form just behind the suture lines in the native aorta, which is more elastic compared to stiff sections of anastomosis and prosthetic graft. Numerous pulsations of the native vessel will likely cause the impairment of the aorta at the margin of the anastomosis. This will lead to disruption of the aortic wall and false aneurysm formation in the native vessel near the area of anastomosis.

Charles University 1st Faculty of Medicine Prague Czech Republic

Czech Technical University Faculty of Mechanical Engineering Laboratory of Cardiovascular Biomechanics Prague Czech Republic

Institute for Clinical and Experimental Medicine Department of Cardiovascular Surgery Prague Czech Republic

Zobrazit více v PubMed

Aebert H, Birnbaum DE (2003). Tuberculous pseudoaneurysms of the aortic arch. J Thorac Cardiovasc Surg 125(2): 411-412. DOI: 0.1067/mtc.2003.130. PubMed DOI

Atik FA, Navia JL, Svensson LG, Vega PR, Feng J, Brizzio ME, et al. (2006). Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg 132(2): 379-385. DOI: 10.1016/j.jtcvs.2006.03.052. PubMed DOI

Dumont E, Carrier M, Cartier R, Pellerin M, Poirier N, Bouchard D, Perrault LP (2004). Repair of aortic false aneurysm using deep hypothermia and circulatory arrest. Ann Thorac Surg 78(1): 117-120; discussion 120-121. DOI: 10.1016/j.athoracsur.2004.01.028. PubMed DOI

Erbel R, Aboyans V, Boileau C, Bossone E, di Bartolomeo RD, Eggebrecht H, et al. (2014). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35(41): 2873-2926. DOI: 10.1093/eurheartj/ehu281. PubMed DOI

Huang LJ, Yu FC, Sun LZ, Tian LX, Chu JM, Lü JH, et al. (2006). Treatment of aortic pseudoaneurysm with interventional procedure. Chin Med J (Engl) 119(7): 612-616. DOI

Katsumata T, Moorjani N, Vaccari G, Westaby S (2000). Mediastinal false aneurysm after thoracic aortic surgery. Ann Thorac Surg 70(2): 547-552. DOI: 10.1016/s0003-4975(00)01300-x. PubMed DOI

Kim J, Baek S (2011). Circumferential variations of mechanical behavior of the porcine thoracic aorta during the inflation test. J Biomech 44(10): 1941-1947. DOI: 10.1016/j.jbiomech.2011.04.022. PubMed DOI

Langanay T, Verhoye JP, Corbineau H, Agnino A, Derieux T, Menestret P, et al. (2002). Surgical treatment of acute traumatic rupture of the thoracic aorta a timing reappraisal? Eur J Cardiothorac Surg 21(2): 282-287. DOI: 10.1016/s1010-7940(01)01133-2. PubMed DOI

Malvindi PG, Cappai A, Raffa GM, Barbone A, Basciu A, Citterio E, et al. (2013). Analysis of postsurgical aortic false aneurysm in 27 patients. Tex Heart Inst J 40(3): 274-280.

Malvindi PG, van Putte BP, Heijmen RH, Schepens MA, Morshuis WJ (2010). Reoperations for aortic false aneurysms after cardiac surgery. Ann Thorac Surg 90(5): 1437-1443. DOI: 10.1016/j.athoracsur.2010.06.103. PubMed DOI

Mohammadi S, Bonnet N, Leprince P, Kolsi M, Rama A, Pavie A, Gandjbakhch I (2005). Reoperation for false aneurysm of the ascending aorta after its prosthetic replacement: surgical strategy. Ann Thorac Surg 79(1): 147-152; discussion 152. DOI: 10.1016/j.athoracsur.2004.06.032. PubMed DOI

Razzouk A, Gundry S, Wang N, Heyner R, Sciolaro C, Van Arsdell G, et al. (1993). Pseudoaneurysms of the aorta after cardiac surgery or chest trauma. Am Surg 59(12): 818-823.

Sommer G, Benedikt C, Niestrawska JA, Hohenberger G, Viertler C, Regitnig P, et al. (2018). Mechanical response of human subclavian and iliac arteries to extension, inflation and torsion. Acta Biomater 75: 235-252. DOI: 10.1016/j.actbio.2018.05.043. PubMed DOI

Sullivan KL, Steiner RM, Smullens SN, Griska L, Meister SG (1988). Pseudoaneurysm of the ascending aorta following cardiac surgery. Chest 93(1): 138-143. DOI: 10.1378/chest.93.1.138. PubMed DOI

Tarraf SA, Kramer B, Vianna E, Gillespie C, Germano E, Emerton KB, et al. (2023). Lengthwise regional mechanics of the human aneurysmal ascending thoracic aorta. Acta Biomater 162: 266-277. DOI: 10.1016/j.actbio.2023.03.023. PubMed DOI

Veljković DŽ, Ranković VJ, Pantović SB, Rosić MA, Kojić MR (2014). Hyperelastic behavior of porcine aorta segment under extension-inflation tests fitted with various phenomenological models. Acta Bioeng Biomech 16(3): 37-45.

Villavicencio MA, Orszulak TA, Sundt TM 3rd, Daly RC, Dearani JA, McGregor CG, et al. (2006). Thoracic aorta false aneurysm: what surgical strategy should be recommended? Ann Thorac Surg 82(1): 81-89; discussion 89. DOI: 10.1016/j.athoracsur.2006.02.081. PubMed DOI