Hemodynamic and biomechanical impact of proximal aortic surgery on the cardiovascular system: a systematic review and meta-analysis.
- 1Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
- 2Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
- 3Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Abstract
The consequences of proximal aortic (PA) replacement with a stiff vascular prosthesis remain insufficiently understood. This systematic review and meta-analysis aims to consolidate evidence regarding the hemodynamic and biomechanical effects of PA surgery on the cardiovascular system. Four databases were searched on April 16th, 2025. Clinical and experimental studies reporting hemodynamic or biomechanical outcomes after PA compliance alterations were included. Exclusion criteria comprised non-original work, computational models, acute procedures, interventions beyond the PA, and PA constriction surgeries. Primary outcomes reflected cardiac functioning, hemodynamics, and aortic biomechanics. Thirteen studies (six clinical, seven experimental) were included. Six studies measured changes pre- and post-intervention, seven studies compared changes to a control group. Pulse pressure (investigated in four studies) significantly increased in one experimental study (37.7±5.9 vs. 49.2±6.9 mmHg, P=0.01). Left ventricular mass (one study) increased significantly following stiff prosthetic replacement versus optimal medical therapy (+3.67±4.1 vs. +0.62±4.4 g/m², P<0.001). Blood flow velocity of the PA (two studies) showed significant increases in both studies. Two (of five) studies reported significant increases in aortic wall mechanics parameters including mean wall shear stress (WSS) (0.31 vs. 0.82 Pa, P=0.04) and maximal WSS (0.55 vs. 1.11 Pa, P=0.04). Meta-analysis (four studies) found increased distensibility [standardized mean change score (SMCC) 0.50, 95% confidence interval (CI): 0.24-0.76, k=3] and circumferential strain (SMCC 0.55, 95% CI: 0.00-1.10, k=3) of the descending aorta. Ejection fraction (SMCC 0.08, 95% CI: -0.29-0.45, k=3) and pulse pressure (SMCC 0.47, 95% CI: -0.36-1.31, k=3) remained unchanged. Certainty of evidence was very low, and risk of bias was moderate. PA stiffening due to a vascular prosthesis appears to have limited systemic hemodynamic effects, likely due to compensatory mechanisms (e.g. increased left ventricular mass and distal aortic adaptation). Local distensibility, WSS and flow dynamics are adversely affected.
Related
- Severe Hypercapnia and Hemodynamic Instability During Carbon Dioxide Insufflation During Robot-Assisted Thoracic Surgery
- Facet joint fusion in lumbar surgery: a biomechanical review of posterior column preservation and reconstruction.
- Review of preoperative tomographic and biomechanical corneal assessment for refractive surgery
- Assessing hemodynamic responses in patients undergoing oral surgery with vasoconstrictor-enhanced local anesthesia: a prospective comparative study between medically compromised and healthy participants
- Hemodynamic Induction of Intracranial Aneurysms via Bilateral Common Carotid Artery Ligation in Rabbits: A Systematic Review and Meta-Analysis
BibTeX
@article{sambeeck2026hemodynamic,
title = {{Hemodynamic and biomechanical impact of proximal aortic surgery on the cardiovascular system: a systematic review and meta-analysis.}},
author = {Pim S van Sambeeck and Bob P Hermans and Foeke J H Nauta and Nesar A Hasami and Nabil Saouti and Michel W A Verkroost and Santi Trimarchi and Martin Czerny and Robin H Heijmen},
journal = {Journal of thoracic disease},
year = {2026},
month = oct,
doi = {10.21037/jtd-2026-2129},
url = {https://europepmc.org/article/MED/42996981},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Hemodynamic and biomechanical impact of proximal aortic surgery on the cardiovascular system: a systematic review and meta-analysis.
AU - Pim S van Sambeeck
AU - Bob P Hermans
AU - Foeke J H Nauta
AU - Nesar A Hasami
AU - Nabil Saouti
AU - Michel W A Verkroost
AU - Santi Trimarchi
AU - Martin Czerny
AU - Robin H Heijmen
PY - 2026
DA - 2026/10/20
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-2129
UR - https://europepmc.org/article/MED/42996981
AB - The consequences of proximal aortic (PA) replacement with a stiff vascular prosthesis remain insufficiently understood. This systematic review and meta-analysis aims to consolidate evidence regarding the hemodynamic and biomechanical effects of PA surgery on the cardiovascular system. Four databases were searched on April 16th, 2025. Clinical and experimental studies reporting hemodynamic or biomechanical outcomes after PA compliance alterations were included. Exclusion criteria comprised non-original work, computational models, acute procedures, interventions beyond the PA, and PA constriction surgeries. Primary outcomes reflected cardiac functioning, hemodynamics, and aortic biomechanics. Thirteen studies (six clinical, seven experimental) were included. Six studies measured changes pre- and post-intervention, seven studies compared changes to a control group. Pulse pressure (investigated in four studies) significantly increased in one experimental study (37.7±5.9 vs. 49.2±6.9 mmHg, P=0.01). Left ventricular mass (one study) increased significantly following stiff prosthetic replacement versus optimal medical therapy (+3.67±4.1 vs. +0.62±4.4 g/m², P<0.001). Blood flow velocity of the PA (two studies) showed significant increases in both studies. Two (of five) studies reported significant increases in aortic wall mechanics parameters including mean wall shear stress (WSS) (0.31 vs. 0.82 Pa, P=0.04) and maximal WSS (0.55 vs. 1.11 Pa, P=0.04). Meta-analysis (four studies) found increased distensibility [standardized mean change score (SMCC) 0.50, 95% confidence interval (CI): 0.24-0.76, k=3] and circumferential strain (SMCC 0.55, 95% CI: 0.00-1.10, k=3) of the descending aorta. Ejection fraction (SMCC 0.08, 95% CI: -0.29-0.45, k=3) and pulse pressure (SMCC 0.47, 95% CI: -0.36-1.31, k=3) remained unchanged. Certainty of evidence was very low, and risk of bias was moderate. PA stiffening due to a vascular prosthesis appears to have limited systemic hemodynamic effects, likely due to compensatory mechanisms (e.g. increased left ventricular mass and distal aortic adaptation). Local distensibility, WSS and flow dynamics are adversely affected.
SN - 2072-1439
SN - 2077-6624
ER -