Total aortic arch replacement: superior ventriculo-arterial coupling with decellularized allografts compared with...

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Hemodynamics

Background:

• Vascular impedance changes after total aortic arch replacement are not well-documented.
• This study compares conventional prostheses with decellularized allografts for aortic arch replacement.

Purpose of the Study:

• To investigate the impact of conventional prostheses versus decellularized allografts on ventriculoarterial coupling and vascular impedance after total aortic arch replacement.
• To evaluate the mechanoenergetic consequences of these replacements.

Main Methods:

• Decellularized aortic arch allografts were characterized in vitro.
• Total aortic arch replacement was performed in dogs using conventional prostheses or decellularized allografts.
• Hemodynamic variables, including aortic flow, pressure, and left ventricular pressure-volume relations, were measured.
• Arterial elastance (Ea), end-systolic elastance (Ees), ventriculoarterial coupling, and characteristic impedance (Z) were calculated.

Main Results:

• Arterial elastance (Ea) increased significantly more with conventional prostheses compared to decellularized allografts.
• Ventriculoarterial coupling was impaired after implantation of conventional prostheses but remained unchanged with decellularized allografts.
• Characteristic impedance (Z) was markedly higher after replacement with conventional prostheses than with decellularized allografts.

Conclusions:

• Conventional prostheses for total aortic arch replacement lead to increased vascular impedance, causing a contractility-afterload mismatch and impaired ventriculoarterial coupling.
• Decellularized allografts preserve vascular impedance, thereby improving ventriculoarterial mechanoenergetics after aortic arch replacement.