From overlooked metric to clinical action: ascending aortic length as a translational breakthrough in elective thoracic aneurysm surgery.

IF 10.1 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2025-10-14 DOI:10.1097/JS9.0000000000003685

Jinlin Wu, Meng Xiao, Duanduan Chen, Jie Chen, Guangyun Zhang

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引用次数: 0

Abstract

Background: Ascending aortic length (AAL) has long been overlooked in assessing the risk of adverse aortic events (AAE) in patients with ascending thoracic aortic aneurysm (ATAA). Our team was among the first globally to investigate AAL's role, and this work contributed to the update of international guidelines. Further, this study aimed to provide mechanistic evidence for AAL as a surgical indicator.

Methods: AAL was measured from the aortic annulus to the origin of the innominate artery along the centerline. Patient-specific FSI models were constructed, and hemodynamic parameters including time-averaged wall shear stress (TAWSS), maximum wall shear stress (WSS), average wall stress (WS), maximum WS, oscillatory shear index (OSI), and particle residence time (PRT) were analyzed.

Results: Compared with the control group (AAL <11 cm), patients with elongated AAL (≥11 cm) showed significantly disturbed hemodynamics: decreased TAWSS (0.8 vs 1.1 Pa, p = 0.002), increased average WS (177 644.5 vs 158 342.8 Pa, p<0.001), increased maximum WS (876 760.0 vs 770 420.0 Pa, p = 0.013), increased average OSI (0.2 ± 0.0 vs 0.1 ± 0.0, p = 0.002), and increased average PRT (2.7 vs 1.9, p<0.001). A strong dose-response relationship was observed when AAL was divided into quartiles (Q1-Q4), with TAWSS decreasing and WS, OSI, PRT increasing progressively with longer AAL (all p<0.001).

Conclusion: Elongated AAL is associated with worsening hemodynamics in a proportional manner, confirming its validity as a surgical indicator for ATAA.

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从被忽视的指标到临床作用：升主动脉长度作为选择性胸动脉瘤手术的转化突破。

背景：在评估升胸主动脉瘤（ATAA）患者不良主动脉事件（AAE）的风险时，升主动脉长度（AAL）一直被忽视。我们的团队是全球首批调查AAL作用的团队之一，这项工作为国际指南的更新做出了贡献。此外，本研究旨在为AAL作为外科指标提供机制证据。方法：沿中心线从主动脉环至无名动脉起始处测量AAL。构建患者特异性FSI模型，分析血流动力学参数，包括时间平均壁剪应力（TAWSS）、最大壁剪应力（WSS）、平均壁剪应力（WS）、最大WS、振荡剪切指数（OSI）和颗粒停留时间（PRT）。结论：AAL延长与血流动力学恶化成正比关系，证实了其作为ATAA手术指标的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.