Dissection flap fenestration can reduce re-apposition force of the false lumen in type-B aortic dissection: a computational and bench study

Front Bioeng Biotechnol. 2024 Mar 28:12:1326190. doi: 10.3389/fbioe.2024.1326190. eCollection 2024.

Abstract

Thoracic endovascular aortic repair (TEVAR) has been widely adopted as a standard for treating complicated acute and high-risk uncomplicated Stanford Type-B aortic dissections. The treatment redirects the blood flow towards the true lumen by covering the proximal dissection tear which promotes sealing of the false lumen. Despite advances in TEVAR, over 30% of Type-B dissection patients require additional interventions. This is primarily due to the presence of a persistent patent false lumen post-TEVAR that could potentially enlarge over time. We propose a novel technique, called slit fenestration pattern creation, which reduces the forces for re-apposition of the dissection flap (i.e., increase the compliance of the flap). We compute the optimal slit fenestration design using a virtual design of experiment (DOE) and demonstrate its effectiveness in reducing the re-apposition forces through computational simulations and benchtop experiments using porcine aortas. The findings suggest this potential therapy can drastically reduce the radial loading required to re-appose a dissected flap against the aortic wall to ensure reconstitution of the aortic wall (remodeling).

Keywords: FEA; acute dissection; aortic dissection; bench validation; simulation; slit fenestration therapy; stent graft; type-B dissection.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work used the Extreme Science and Engineering Discovery Environment (XSEDE), supported by National Science Foundation grant number ACI-1548562. This work used the Extreme Science and Engineering Discovery Environment (XSEDE) Comet supercomputer located at the San Diego Supercomputer Center through allocation Charge # TG-MCB170015. 3DT Holdings and Cook Medical funded this research.