Skip to main content
SpringerLink
Log in

Impact of Ascending Aorta Replacement on Ventricle Load and “Windkessel” Function

  • Chapter
  • First Online:
Surgical Management of Aortic Pathology

  • 1664 Accesses

Abstract

The native aorta is a highly flexible vessel featuring a smart volume storage and distribution capacity, the so-called Windkessel, which contributes to a particular mode of blood distribution through the arterial system. In case of prosthetic replacement of parts of the aorta, particularly the ascending, a certain amount of the Windkessel function gets lost due to the minimal elasticity of the commonly applied vascular prostheses. This stiffening increases the load of the left ventricle and also impacts residual parts of the aorta.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wolinsky H, Glagov S. A lamellar unit of aortic medial structure and function in mammals. Circ Res. 1967;20:99–111.

    Article  CAS  Google Scholar 

  2. Boudoulas H, Wooley CF. Aortic function. J Heart Valve Dis. 1996;5:258–63.

    Google Scholar 

  3. Westerhof N, Lankhaar JW, Westerhof BE. The arterial windkessel. Med Biol Eng Comput. 2009;47:131–41.

    Article  Google Scholar 

  4. Frank O. Die grundform des arteriellen pulses. Z Biol. 1899;37:483–586.

    Google Scholar 

  5. Stefanadis C, Stratos S, Vlachopoulos C, Marakas S, Boudoulas H, Kallikazaros I, Tsiamis E, Toutouzas K, Sioros L, Toutouzas P. Pressure-diameter relation of the human aorta. A new method of determination by the application of a special ultrasonic dimension catheter. Circulation. 1995;92:2210–4.

    Article  CAS  Google Scholar 

  6. Reymond P, Westerhof N, Stergiopulos N. Systolic hypertension mechanism: effect of global and local proximal aorta stiffening on pulse pressure. Ann Biomed Eng. 2012;40:742–9.

    Article  Google Scholar 

  7. Oishi Y, Miyoshi H, Mizuguchi Y, Iuchi A, Nagase N, Oki T. Aortic stiffness is strikingly increased with age ≥ 50 years in clinically normal individuals and preclinical patients with cardiovascular risk factors: assessment by the new technique of 2D strain echocardiography. J Cardiol. 2011;57:354–9.

    Article  Google Scholar 

  8. Redheuil A, Yu WC, Mousseaux E, Harouni AA, Kachenoura N, Wu CO, et al. Age-related changes in aortic arch geometry: relationship with proximal aortic function and left ventricular mass and remodeling. J Am Coll Cardiol. 2011;58:1262–70.

    Article  Google Scholar 

  9. Erasmi A, Sievers HH, Scharfschwerdt M, Eckel T, Misfeld M. In vitro hydrodynamics, cusp bending deformation and root distensibility for different types of aortic valve sparing operations: Remodeling, sinus prosthesis and reimplantation. J Thorac Cardiovasc Surg. 2005;130:1044–9.

    Article  Google Scholar 

  10. Berdajs D, Mosbahi S, Strano F, Forro Z, Burki M, von Segesser LK. Impact of synthetic elements on aortic root haemodynamics: computed fluid dynamics of root reconstruction and valve reimplantation. Eur J Cardiothorac Surg. 2017;51:432–41.

    PubMed  Google Scholar 

  11. Kolh P, d’Orio V, Lambermont B, Gerard P, Gommes C, Limet R. Increased aortic compliance maintains left ventricular performance at lower energetic cost. Eur J Cardiothorac Surg. 2000;17:272–8.

    Article  CAS  Google Scholar 

  12. Morita S, Asou T, Kuboyama I, Harasawa Y, Sunagawa K, Yasui H. Inelastic vascular prosthesis for proximal aorta increases pulsatile arterial load and causes left ventricular hypertrophy in dogs. J Thorac Cardiovasc Surg. 2002;124:768–74.

    Article  Google Scholar 

  13. Bauernschmitt R, Schulz S, Schwarzhaupt A, Kienke U, Vahl CF, Lange R, Hagl S. Simulation of arterial hemodynamics after partial prosthetic replacement of the aorta. Ann Thorac Surg. 1999;67:676–82.

    Article  CAS  Google Scholar 

  14. Scharfschwerdt M, Sievers HH, Greggersen J, Hanke T, Misfeld M. Prosthetic replacement of the ascending aorta increases wall tension in the residual aorta. Ann Thorac Surg. 2007;83:954–7.

    Article  Google Scholar 

  15. Beckmann A, Funkat AK, Lewandowski J, Frie M, Ernst M, Hekmat K, et al. German heart surgery report 2015: the annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg. 2016;64:462–74.

    Article  Google Scholar 

  16. De Paulis R, Centrano E, Moscarelli M, Andò G, Bertoldo F, Scaffa R, et al. Effects of ascending aorta replacement on aortic root dilatation. Eur J Cardiothorac Surg. 2005;27:86–9.

    Article  Google Scholar 

  17. Kunihara T, Neumann N, Kriechbaum SD, Nomura R, Schäfers HJ. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J. 2017;81:1824–31. https://doi.org/10.1253/circj.CJ-17-0182.

    Article  PubMed  Google Scholar 

  18. Detter C, Mair H, Klein HG, Georgescu C, Welz A, Reichart B. Long-term prognosis of surgically-treated aortic aneurysms and dissections in patients with and without Marfan syndrome. Eur J Cardiothorac Surg. 1998;13:416–23.

    Article  CAS  Google Scholar 

  19. Carrel T, Beyeler L, Schnyder A, Zurmühle P, Berdat P, Schmidli J, Eckstein FS. Reoperations and late adverse outcome in Marfan patients following cardiovascular surgery. Eur J Cardiothorac Surg. 2004;25:671–5.

    Article  Google Scholar 

  20. Scharfschwerdt M, Leonhard M, Lehmann J, Richardt D, Goldmann H, Sievers HH. In vitro investigation of a novel elastic vascular prosthesis for valve-sparing aortic root and ascending aorta replacement. Eur J Cardiovasc Surg. 2016;49:1370–3.

    Article  Google Scholar 

  21. Yeh CH, Chen MC, Wu YC, Wang YC, Chu JJ, Lin PJ. Risk factors for descending aortic aneurysm formation in medium-term follow-up of patients with type A aortic dissection. Chest. 2003;124:989–95.

    Article  Google Scholar 

  22. Geirsson A, Bavaria JA, Swarr D, Keane MG, Woo YJ, Szeto WY, et al. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgiccal reconstruction algorithm. Ann Thorac Surg. 2007;84:1955–64.

    Article  Google Scholar 

  23. Iribarne A, Keenan J, Benrashid E, Wang H, Meza JM, Ganapathi A, et al. Imaging surveillance after proximal aortic operations: is it necessary? Ann Thorac Surg. 2017;103:734–41.

    Article  Google Scholar 

  24. Engelfriet PM, Boersma E, Tijssen JG, Bouma BJ, Mulder BJ. Beyond the root: dilatation of the distal aorta in the Marfan’s syndrome. Heart. 2006;92:1238–43.

    Article  CAS  Google Scholar 

  25. Girdauskas E, Kuntze T, Borger MA, Falk V, Mohr FW. Distal aortic reinterventions after root surgery in Marfan patients. Ann Thorac Surg. 2008;86:1815–20.

    Article  Google Scholar 

  26. Schoenhoff FS, Jungi S, Czerny M, Roost E, Reineke D, Matjas G, et al. Acute aortic dissection determines the fate of initially untreated aortic segments in Marfan syndrome. Circulation. 2013;127:1567–75.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany

    Michael Scharfschwerdt

Authors
  1. Michael Scharfschwerdt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Scharfschwerdt .

Editor information

Editors and Affiliations

  1. Fmr Royal Brompton Hospital, London, UK

    Olaf H. Stanger

  2. Royal Brompton Hospital, London, UK

    John R. Pepper

  3. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Lars G. Svensson

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer-Verlag GmbH Austria, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Scharfschwerdt, M. (2019). Impact of Ascending Aorta Replacement on Ventricle Load and “Windkessel” Function. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_60

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-4874-7_60

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-4872-3

  • Online ISBN: 978-3-7091-4874-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation