Key result
Computational simulations demonstrated that an oversized frozen elephant trunk increases circumferential stress, while an undersized one increases wall shear stress, both potentially causing dSINE.
Why the study?
Distal stent graft-induced new entry is a complication of the frozen elephant trunk technique lacking established preventive measures, motivating simulation of the mechanical environment to clarify its mechanisms.
Does the oversizing rate of frozen elephant trunk (FET) affect the mechanical stress and wall shear stress at the distal edge of the aorta?
Does the oversizing rate of frozen elephant trunk (FET) affect the mechanical stress and wall shear stress at the distal edge of the aorta?
Computational modeling demonstrates that both oversized and undersized frozen elephant trunks can cause distal stent graft-induced new entry through different biomechanical mechanisms, suggesting that simply selecting a smaller-sized FET may not prevent this complication.
OBJECTIVES: Distal stent graft-induced new entry (dSINE), a new intimal tear at the distal edge of the frozen elephant trunk (FET), is a complication of FET. Preventive measures for dSINE have not yet been established. This study aimed to clarify the mechanisms underlying the development of dSINE by simulating the mechanical environment at the distal edge of the FET. METHODS: The stress field in the aortic wall after FET deployment was calculated using finite element analysis. Blood flow in the intraluminal space of the aorta and FET models was simulated using computational fluid dynamics. The simulations were conducted with various oversizing rates of FET ranging from 0 to 30% under the condition of FET with elastic recoil. RESULTS: The elastic recoil of the FET, which caused its distal edge to push against the greater curvature of the aorta, induced a concentration of circumferential stress and increased wall shear stress (WSS) at the aorta. Elastic recoil also created a discontinuous notch on the lesser curvature of the aorta, causing flow stagnation. An increase in the oversizing rate of the FET widened the large circumferential stress area on the greater curvature and increases the maximum stress. Conversely, a decrease in the oversizing rate of the FET increased the WSS and widened the area with high WSS. CONCLUSIONS: Circumferential stress concentration due to an oversized FET and high WSS due to an undersized FET can cause a dSINE. The selection of smaller-sized FET alone might not prevent dSINE.
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Morodomi et al. (2024) studied Distal stent graft-induced new entry (dSINE) after frozen elephant trunk (FET). Frozen elephant trunk (FET) oversizing rates (0 to 30%) was evaluated on Stress field (circumferential stress) and wall shear stress (WSS) at the aorta. Computational simulations demonstrated that an oversized frozen elephant trunk increases circumferential stress, while an undersized one increases wall shear stress, both potentially causing dSINE.
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