Gender differences in the dissection properties of ascending thoracic aortic aneurysms

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Abstract

OBJECTIVES

Presentation, management and outcomes in the aortic dissection (AD) of ascending thoracic aortic aneurysm (ATAA) differ in gender and age. The purpose of this study is to investigate the dissection properties of male and female ATAAs.

METHODS

Peeling tests were performed to quantitatively determine the delamination strength and dissection energy of 41 fresh ATAA samples (22 males and 19 females) in relatively young (≤65 years) and elderly (>65 years) patients. The delamination strength of the ATAAs was further correlated with patient ages for males and females. The histological investigation was employed to characterize the dissected morphology.

RESULTS

For elderly patients, circumferential and longitudinal delamination strengths of the female ATAAs were statistically significantly lower than those of the males (circumferential: 31 ± 6 vs 42 ± 6 mN/mm, P < 0.01; longitudinal: 35 ± 7 vs 49 ± 10 mN/mm, P = 0.02). No significant differences were found in the delamination strength between males and females for relatively young patients. The circumferential and longitudinal delamination strengths were significantly decreased and strongly correlated with patient ages for females. However, these correlations were not present in males. Dissection routes propagated in the aortic media to create ruptured surfaces for all specimens. Peeling tests of the male ATAAs generate rougher surfaces than females.

CONCLUSIONS

There is a higher propensity of AD occurrence for the elderly females as compared to males with matched ages. Surgeons should be cognizant of the risk of AD onset later in life, especially in females.

Abstract

Ascending thoracic aortic aneurysm (ATAA) is a clinically significant pathology associated with high morbidity and mortality [1, 2].

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Most cited references 25

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Determination of layer-specific mechanical properties of human coronary arteries with nonatherosclerotic intimal thickening and related constitutive modeling.

Gerhard A. Holzapfel, Gerhard Sommer, Christian T Gasser … (2005)

At autopsy, 13 nonstenotic human left anterior descending coronary arteries [71.5 +/- 7.3 (mean +/- SD) yr old] were harvested, and related anamnesis was documented. Preconditioned prepared strips (n = 78) of segments from the midregion of the left anterior descending coronary artery from the individual layers in axial and circumferential directions were subjected to cyclic quasi-static uniaxial tension tests, and ultimate tensile stresses and stretches were documented. The ratio of outer diameter to total wall thickness was 0.189 +/- 0.014; ratios of adventitia, media, and intima thickness to total wall thickness were 0.4 +/- 0.03, 0.36 +/- 0.03, and 0.27 +/- 0.02, respectively; axial in situ stretch of 1.044 +/- 0.06 decreased with age. Stress-stretch responses for the individual tissues showed pronounced mechanical heterogeneity. The intima is the stiffest layer over the whole deformation domain, whereas the media in the longitudinal direction is the softest. All specimens exhibited small hysteresis and anisotropic and strong nonlinear behavior in both loading directions. The media and intima showed similar ultimate tensile stresses, which are on average three times smaller than ultimate tensile stresses in the adventitia (1,430 +/- 604 kPa circumferential and 1,300 +/- 692 kPa longitudinal). The ultimate tensile stretches are similar for all tissue layers. A recently proposed constitutive model was extended and used to represent the deformation behavior for each tissue type over the entire loading range. The study showed the need to model nonstenotic human coronary arteries with nonatherosclerotic intimal thickening as a composite structure composed of three solid mechanically relevant layers with different mechanical properties. The intima showed significant thickness, load-bearing capacity, and mechanical strength compared with the media and adventitia.

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Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002.

Christian Olsson, E Ståhle, Fredrik Granath … (2006)

Current knowledge of prevalence, incidence, and survival in thoracic aortic diseases (aneurysm and dissection) is based on small studies from a dated era of treatment and diagnostic procedures. The objective of the present study was to reappraise epidemiology and long-term outcomes in subjects with thoracic aortic disease in a large contemporary population. All subjects with thoracic aortic aneurysm or dissection identified in Swedish national healthcare registers from 1987 to 2002 were included in the present study. Of 14,229 individuals with thoracic aortic disease, 11,039 (78%) were diagnosed before death. Incidence of thoracic aortic disease rose by 52% in men and by 28% in women to reach 16.3 per 100,000 per year and 9.1 per 100,000 per year, respectively. Operations increased 7-fold in men and 15-fold in women over time. Of the 2455 patients who underwent operation, 389 (16%) died within 30 days, with older age and thoracic aortic rupture as risk factors. In Cox analysis, increasing age was the only variable associated with long-term mortality. Both short- and long-term mortality improved over time. In patients who underwent operation, actuarial survival (95% CI) at 1, 5, and 10 years was 92% (91% to 93%), 77% (75% to 80%), and 57% (53% to 61%), respectively. The cumulative incidence of thoracic aortic reoperations was 7.8% at 10 years. The prevalence and incidence of thoracic aortic disease was higher than previously reported and increasing. The annual number of operations increased substantially. Surgical (30-day) and long-term survival improved significantly over time to form a growing cohort of patients needing counseling, management decisions, operations, and extended postoperative surveillance.

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Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.

Sean Coady, John Elefteriades, G Kopf … (2001)

Prior work has clarified the cumulative, lifetime risk of rupture or dissection based on the size of thoracic aneurysms. Ability to estimate simply the yearly rate of rupture or dissection would greatly enhance clinical decision making for specific patients. Calculation of such a rate requires robust data. Data on 721 patients (446 male, 275 female; median age, 65.8 years; range, 8 to 95 years) with thoracic aortic disease was prospectively entered into a computerized database over 9 years. Three thousand one hundred fifteen imaging studies were available on these patients. Five hundred seventy met inclusion criteria in terms of length of follow-up and form the basis for the survival analysis. Three hundred four patients were dissection-free at presentation; their natural history was followed for rupture, dissection, and death. Patients were excluded from analysis once operation occurred. Five-year survival in patients not operated on was 54% at 5 years. Ninety-two hard end points were realized in serial follow-up, including 55 deaths, 13 ruptures, and 24 dissections. Aortic size was a very strong predictor of rupture, dissection, and mortality. For aneurysms greater than 6 cm in diameter, rupture occurred at 3.7% per year, rupture or dissection at 6.9% per year, death at 11.8%, and death, rupture, or dissection at 15.6% per year. At size greater than 6.0 cm, the odds ratio for rupture was increased 27-fold (p = 0.0023). The aorta grew at a mean of 0.10 cm per year. Elective, preemptive surgical repair restored life expectancy to normal. This study indicates that (1) thoracic aneurysm is a lethal disease; (2) aneurysm size has a profound impact on rupture, dissection, and death; (3) for counseling purposes, the patient with an aneurysm exceeding 6 cm can expect a yearly rate of rupture or dissection of at least 6.9% and a death rate of 11.8%; and (4) elective surgical repair restores survival to near normal. This analysis strongly supports careful radiologic follow-up and elective, preemptive surgical intervention for the otherwise lethal condition of large thoracic aortic aneurysm.

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Author and article information

Journal

Journal ID (nlm-ta): Interact Cardiovasc Thorac Surg

Journal ID (iso-abbrev): Interact Cardiovasc Thorac Surg

Journal ID (publisher-id): icvts

Title: Interactive Cardiovascular and Thoracic Surgery

Publisher: Oxford University Press

ISSN (Print): 1569-9293

ISSN (Electronic): 1569-9285

Publication date Collection: August 2022

Publication date (Electronic): 14 March 2022

Publication date PMC-release: 14 March 2022

Volume: 35

Issue: 2

Electronic Location Identifier: ivac068

Affiliations

[1 ] Institute for Biomedical Engineering and Nano Science, Shanghai East Hospital, Tongji University School of Medicine , Shanghai, China

[2 ] Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, and Shanghai Institute of Cardiovascular Diseases , Shanghai, China

[3 ] Department of Pathology and Pathophysiology, Tongji University School of Medicine , Shanghai, China

Author notes

[†]

Jianhua Tong, Mieradilijiang Abudupataer contributed equally to this work.

Corresponding authors. Tongji University School of Medicine, Chifeng Road 67, Shanghai 200092, China. Tel: +86-21-65988029; e-mail: tongjh@ 123456tongji.edu.cn (J. Tong); Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. Tel: +86-21-64041990; e-mail: wangchunsheng@ 123456fudan.edu.cn (C. Wang); Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. Tel: +86-21-64041990; e-mail: zhu.kai1@ 123456zs-hospital.sh.cn (K. Zhu).

Article

Publisher ID: ivac068

DOI: 10.1093/icvts/ivac068

PMC ID: 9297518

PubMed ID: 35285896

SO-VID: a70ce5a2-700d-4579-9b4c-b6114aeed6a4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 January 2022

Date accepted : 09 March 2022

Page count

Pages: 9

Funding

Funded by: National Natural Science Foundation of China, DOI 10.13039/501100001809;

Award ID: 81771971

Funded by: Science and Technology Commission of Shanghai Municipality, DOI 10.13039/501100003399;

Award ID: 20ZR1411700

Gender differences in the dissection properties of ascending thoracic aortic aneurysms

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Abstract

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Hearing Loss and Restoration

Most cited references 25

Determination of layer-specific mechanical properties of human coronary arteries with nonatherosclerotic intimal thickening and related constitutive modeling.

Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002.

Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.

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