Engineering Approach to Study the Effect of TEVAR on the Cardiovascular System: A Systematic Review

Abstract

Background

To study the effect of endovascular treatment of the thoracic aorta on cardiac geometry and evaluate the effects of stent placement on hemodynamics and cardiovascular biomechanics.

Methods

Articles were selected through the use of online databases such as PubMed, Scopus, and Web of Science, investigating the use of engineering methods (computational analysis and simulations using three-dimensional models of cardiovascular structures obtained from medical imaging) to study the effects of pretreatment and posttreatment Thoracic Endovascular Aortic Repair (TEVAR) in terms of left ventricular mass variation and assessment of fluid dynamics parameters such as Wall Shear Stress (WSS), flow variations, and velocity. The quality of the included studies was assessed using the Newcastle-Ottawa scale.

Results

A total of 11 studies were considered: 3 reported data on left ventricular mass variation, 5 reported flow and velocity variations, and 6 provided information on WSS. A high discrepancy in results and methodology for conducting the analyses was observed. Overall, an increase in left ventricular mass was observed in patients undergoing TEVAR, while an improvement in flow conditions and stress was noted following the exclusion of the pathological aortic zone.

Conclusions

To summarize, TEVAR can result in changes in vascular structures. However, the current literature on this topic is limited and the analysis methods used vary in terms of methodology, treated pathology, and follow-up duration. To successfully integrate computational simulations and engineering evaluations of medical images into clinical practice, it is crucial to standardize the analysis methods.