See the published version of this preprint at Journal of Cardiothoracic Surgery.
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Research article
Timothy Luke Surman
Royal Adelaide Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5460-8431
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations.
Methods
We developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.
Results
In the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure.
Conclusion
Our results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.
Keywords
Ascending aorta aneurysms, Ascending aortic dissection, aortic root, thoracic aorta, inflation testing
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of Cardiothoracic Surgery.
Version 2
Posted 03 Sep, 2020
No community comments so far
Editorial decision: Accept
On 01 Sep, 2020
Editor assigned
On 31 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
No comments provided
Editorial decision: Major revision
On 08 Aug, 2020
Review #2 received
Received 28 Jun, 2020
Review #1 received
Received 22 Jun, 2020
Reviewer #2 agreed
On 10 Jun, 2020
Reviewer #1 agreed
On 08 Jun, 2020
Reviewers invited
Invitations sent on 07 Jun, 2020
Editor assigned
On 17 Apr, 2020
First submitted
On 16 Apr, 2020
Submission checks complete
On 16 Apr, 2020
Editor invited
On 16 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiothoracic Surgery
Learn more about our company.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Journal of Cardiothoracic Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Timothy Luke Surman
Royal Adelaide Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5460-8431
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of Cardiothoracic Surgery.
Version 2
Posted 03 Sep, 2020
No community comments so far
Editorial decision: Accept
On 01 Sep, 2020
Editor assigned
On 31 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
No comments provided
Editorial decision: Major revision
On 08 Aug, 2020
Review #2 received
Received 28 Jun, 2020
Review #1 received
Received 22 Jun, 2020
Reviewer #2 agreed
On 10 Jun, 2020
Reviewer #1 agreed
On 08 Jun, 2020
Reviewers invited
Invitations sent on 07 Jun, 2020
Editor assigned
On 17 Apr, 2020
First submitted
On 16 Apr, 2020
Submission checks complete
On 16 Apr, 2020
Editor invited
On 16 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiothoracic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Journal of Cardiothoracic Surgery.
Background
The aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations.
Methods
We developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.
Results
In the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure.
Conclusion
Our results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
This is a list of supplementary files associated with this preprint. Click to download.
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