Long-Term Longitudinal Computational Study of a Marfan Syndrome Patient After Hybrid Repair of Aortic Arch Dissection With Parallel Stent-Grafts

Abstract

Hybrid repair is a valuable alternative treatment for aortic arch disease in Marfan syndrome patients after proximal aorta replacement. This study aimed to investigate the long-term durability of this technique with the use of parallel stent-grafts and evaluate strategies to prevent abdominal aortic dilation. One Marfan syndrome patient who underwent hybrid aortic repair with parallel stent-grafts for arch dissection after the Bentall procedure was admitted. Five patient-specific three-dimensional models were reconstructed based on preoperative and follow-up computed tomography angiography scans. Three hypothetical models addressing the closure of an endoleak or reentry tears were created. Hemodynamic parameters were assessed using computational fluid dynamics. Postoperatively, increased blood flow into the descending aorta and rising abdominal aortic pressure were observed. During the 5-year follow-up, no new thoracic aorta-related adverse events occurred. One early type III endoleak persisted, and three reentry tears were identified in the descending aorta. The abdominal aorta dilated from 31 to 49 mm. Simultaneously addressing both the endoleak and reentry tears was more effective in reducing false lumen pressure and flow velocity in the abdominal aorta and expanding the high-value relative residence time region. Longitudinal follow-up imaging demonstrated the long-term durability of hybrid aortic arch repair with parallel stent-grafts in a Marfan syndrome patient after ascending aorta replacement. The increased pressure resulting from blood flow redistribution was associated with downstream aortic dilation. Furthermore, computational fluid dynamics simulations can offer predictive analyses for optimizing intervention strategies in the treatment of distal aneurysmal degeneration.