Biomechanical Simulation of the Outcomes of Reduction Aortoplasty Surgery in Patients Eligible for Aortic Valve Replacement: A Case Study of Referrals to Hazrat Rasul Akram Hospital During 1402–1403

Behzadi, Amir Hosein; Zeraatian Nejad Davani, Sam; Eghbali, Foolad

Biomechanical Simulation of the Outcomes of Reduction Aortoplasty Surgery in Patients Eligible for Aortic Valve Replacement: A Case Study of Referrals to Hazrat Rasul Akram Hospital During 1402–1403

Document Type : Original Article

Authors

Amir Hosein Behzadi ¹

Sam Zeraatian Nejad Davani ²

Foolad Eghbali ³

¹ General Surgery Resident, Department of General Surgery, Rasool Akram Hospital School of Medicine, Iran University of Medical Sciences, Tehran, Iran

² Attending Professor of Cardiovascular Surgery in IUMS - Iran and Fellow of Advanced Thoracic Organs Transplantation in NWU and NM Illinois

³ Associate Professor of General Surgery, Department of General Surgery, Rasool Akram Hospital School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background and Objective: Aortic surgeries are among the most complex and critical procedures in cardiology and vascular surgery. Reducible aortoplasty offers a viable alternative to ascending aorta grafting for patients with moderate aortic dilation. This study aims to evaluate the hemodynamic effects of reducible aortoplasty and compare clinical outcomes with predictions derived from numerical simulations.
Materials & Methods: A retrospective analysis was performed on data from four patients who underwent reducible aortoplasty. Blood pressure measurements were recorded both preoperatively and postoperatively. To assess hemodynamic changes, we utilized echocardiography, supplemented by finite element modeling (FEM) and numerical simulations. The patients' radiological data were analyzed using Abaqus software in conjunction with the finite element method.
Results: In Case 1, involving a 56-year-old male, minimal alterations in blood pressure were observed post-surgery, with simulation predictions closely aligning with echocardiographic findings. Case 2 involved a 62-year-old male who exhibited a significant postoperative reduction in blood pressure, corroborated by the computational model's results. Case 3, a 75-year-old female, developed aortic valve failure following surgery, an outcome inconsistent with the numerical predictions. In Case 4, a 70-year-old male showed a substantial postoperative decrease in blood pressure, consistent with simulation predictions.
Conclusion: The findings of this study highlight the efficacy of FEM and numerical simulations in evaluating surgical outcomes. However, to enhance the accuracy and reliability of these predictions, it is essential to address current limitations. Improving numerical models to incorporate individualized patient characteristics, providing advanced training for healthcare professionals in modeling techniques, and conducting further investigations may contribute to improved clinical outcomes for patients undergoing aortic surgeries.

Keywords

Reducible aortoplasty

aortic aneurysm

hemodynamics

numerical simulation

finite element method

cardiovascular surgery

1. Celik NB, Alomari M, Garg P, Sareyyupoglu B, Pham SM. Reduction aortoplasty of donor ascending aorta aneurysm during heart transplant: A case report. JTCVS techniques. 2024; 24: 117-20.

2. James A, Gibbs C. Reduction Aortoplasty Using Xenograft Pericardium. Heart, Lung and Circulation. 2024; 33: S17.

3. Gill M, Dunning J. Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta? Interactive CardioVascular and Thoracic Surgery. 2009. 7-9: 693.

4. Robicsek F, Cook JW, Reames Sr MK, Skipper ER. Size reduction ascending aortoplasty: is it dead or alive? The Journal of Thoracic and Cardiovascular Surgery. 2004; 128: 562-70.

5. Arsan S. How to avoid problems with reduction aortoplasty. The Annals of thoracic surgery. 2004; 78: 386-7.

6. Belov IV, Stepanenko AB, Gens AP, Savichev DD, Charchyan ER. Reduction aortoplasty for ascending aortic aneurysm: a 14-year experience. Asian Cardiovascular and Thoracic Annals. 2009; 17:
162-6.

7. Sherifova S, Holzapfel GA. Biomechanics of aortic wall failure with a focus on dissection and aneurysm: a review. Acta biomaterialia. 2019; 99: 1-17.

8. Kassab GS. Biomechanics of the cardiovascular system: the aorta as an illustratory example. Journal of the Royal Society Interface. 2006; 3: 719-40.

9. Bäck M, Gasser TC, Michel J-B, Caligiuri G. Biomechanical factors in the biology of aortic wall and aortic valve diseases. Cardiovascular research. 2013; 99: 232-41.

10. Kim J, Peruski B, Hunley C, Kwon S, Baek S. Influence of surrounding tissues on biomechanics of aortic wall. International journal of experimental and computational biomechanics. 2013; 2: 105-17.

11. Chung JCY, Wong E, Tang M,
Eliathamby D, Forbes TL, Butany J, et al. Biomechanics of aortic dissection: a comparison of aortas associated with bicuspid and tricuspid aortic valves. Journal of the American Heart Association. 2020; 9: e016715.

12. Vorp DA, Schiro BJ, Ehrlich MP, Juvonen TS, Ergin MA, Griffith BP. Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta. The Annals of thoracic surgery. 2003; 75: 1210-4.

13. Fedorov A, Beichel R, Kalpathy-Cramer J,
Finet J, Fillion-Robin JC, Pujol S, et al. 3D
Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging. 2012; 30: 1323-41.

14. Bathe KJ. Finite element method. Wiley encyclopedia of computer science and engineering. 2007: 1-12.

15. Dhatt G, Lefrançois E, Touzot G. Finite element method: John Wiley & Sons; 2012.

16. Holzapfel GA, Gasser TC, Ogden RW. A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models. Journal of elasticity and the physical science of solids. 2000; 61: 1-48.

17. Vorp DA, Schiro BJ, Ehrlich MP, Juvonen TS, Ergin MA, Griffith BP. Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta. Ann Thorac Surg. 2003; 75: 1210-4.

18. Milnor WR. Hemodynamics. 2nd ed. Baltimore: Williams & Wilkins; 1989.

19. Morbiducci U, Ponzini R, Rizzo G,
Cadioli M, Esposito A, Montevecchi FM, et al. Mechanistic insight into the physiological relevance of helical blood flow in the human aorta: an in
vivo study. Biomech Model Mechanobiol. 2011; 10: 339-55.

20. Stankovic Z, Allen BD, Garcia J, Jarvis KB, Markl M. 4D flow imaging with MRI. Cardiovasc Diagn Ther. 2014; 4: 173-92.

21. Pasta S, Phillippi JA, Gleason TG, Vorp DA. Effect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta. J Thorac Cardiovasc Surg. 201. 7-143: 460; 2.

22. Martufi G, Gasser TC, Appoo JJ, Di Martino ES. Mechano-biology in the thoracic aortic aneurysm: a review and case study. Biomech Model Mechanobiol. 2014; 13: 917-28.

23. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018; 67: 2-77.e2.

24. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019; 57: 8-93.

25. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011; 58: 2020-45.

26. Coady MA, Rizzo JA, Hammond GL, Mandapati D, Darr U, Kopf GS, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg. 1997; 113: 476-91; discussion 89-91.

27. Davies RR, Goldstein LJ, Coady MA, Tittle SL, Rizzo JA, Kopf GS, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002; 73: 17-27; discussion -8.

28. Girardin L. Patient-specific CFD workflows for haemodynamics assessment of Aortic Dissection interventions informed by multi-modal clinical data: UCL (University College London); 2025.

29. Ramses R, Agu O. From Heart to Abdominal Aorta: Integrating Multi-Modal Cardiac Imaging Derived Haemodynamic Biomarkers for
Abdominal Aortic Aneurysm Risk Stratification, Surveillance, Pre-Operative Assessment and Therapeutic Decision-Making. Diagnostics. 2025; 15: 2497.

30. Catalano C, Crascì F, Puleo S, Scuoppo R, Pasta S, Raffa GM. Computational fluid dynamics in cardiac surgery and perfusion: A review. Perfusion. 2025; 40: 362-70.

31. Bardi F. Combined in-vitro and in-silico investigations of aortic hemodynamics: Ecole Nationale Supérieure des Mines de Saint-Etienne; 2024.

32. Loly VT, Cintra A, Ramirez-Velandia F, Ogilvy CS, Mensah EO, de Sá Brasil Lima J, et al. Computational Fluid Dynamics Approaches for Analyzing Rupture and Growth of Intracranial Aneurysms: A Systematic Review. Biomedicines. 2025; 13: 2914.