Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

Xiaoning Sun; Siting Li; Yuan He; Yuxi Liu; Tianxiang Ma; Rong Zeng; Zhili Liu; Yu Chen; Yuehong Zheng; Xiao Liu

doi:10.3389/fphys.2022.1114110

Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

Front Physiol. 2023 Jan 10:13:1114110. doi: 10.3389/fphys.2022.1114110. eCollection 2022.

Authors

Xiaoning Sun^{1

2}, Siting Li^{1

2}, Yuan He³, Yuxi Liu³, Tianxiang Ma³, Rong Zeng¹, Zhili Liu¹, Yu Chen³, Yuehong Zheng^{1

2}, Xiao Liu³

Affiliations

¹ Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
² Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³ Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.

Abstract

Introduction: Chronic heart disease (CHD) is a common comorbidity of patients receiving endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA). The explicit relationship between ventricular systolic function and EVAR complication of thrombotic events is unknown. Methods: In this study, we proposed a three-dimensional numerical model coupled with the lumped-elements heart model, which is capable of simulating thrombus formation in diverse systolic functions. The relation of cardiac functions and the predicted risk of thrombus formation in the aorta and/or endograft of 4 patients who underwent EVAR was investigated. Relative risks for thrombus formation were identified using machine-learning algorithms. Results: The computational results demonstrate that thrombus tended to form on the interior side of the aorta arch and iliac branches, and cardiac function can affect blood flow field and affect thrombus formation, which is consistent with the four patients' post-operative imaging follow-up. We also found that RRT, OSI, TAWSS in thrombosis area are lower than whole average. In addition, we found that the thrombus formation has negative correlations with the maximum ventricular contractile force (r = -.281 ± .101) and positive correlations with the minimum ventricular contractile force (r = .238 ± .074), whereas the effect of heart rate (r = -.015 ± .121) on thrombus formation is not significant. Conclusion: In conclusion, changes in ventricular systolic function may alter the risk of thrombotic events after EVAR repair, which could provide insight into the selection of adjuvant therapy strategies for AAA patients with CHD.

Keywords: abdominal aortic aneurysms; computational model; hemodynamics; thrombus; ventricular systolic function.

Grants and funding

This work was supported by the National Natural Science Research Foundation of China (Grant No. 11827803, 31971244, 31570947, 32071311, U20A20390, 51890894, 82070492, and 82100519), the Fundamental Research Funds for the General Universities (KG16186101) and the 111 Project (B13003). The CAMS Innovation fund for Medical Science (CIFMS, Grant No. 2021-I2M-C&T-A-006 and 2021-I2M-1-016), and the National High Level Hospital Clinical Research Funding (Grant No. 2022-PUMCH-B-100 and 2022-PUMCH-A-190). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.