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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT02860182
Other study ID # 2013-08
Secondary ID
Status Recruiting
Phase N/A
First received July 29, 2016
Last updated August 30, 2016
Start date January 2014
Est. completion date August 2016

Study information

Verified date July 2016
Source Assistance Publique Hopitaux De Marseille
Contact Mourad Boufi
Phone 04 91 38 27 47
Email drci@ap-hm.fr
Is FDA regulated No
Health authority France: Ethics Committee
Study type Observational

Clinical Trial Summary

Acute type A aortic dissection is a frequent (3 cases per 100 000 people per year) and severe (spontaneous mortality 70%), needing an emergency surgical treatment. Surgical outcomes have improved with the development of surgical techniques, but the postoperative mortality remains high (15-30% at 30 days). Endovascular approach with the deployment of endoprosthesis sealing the proximal intimal tear is an attractive minimally invasive technique, which can represent an alternative to surgical repair especially in high risk patients.


Description:

Objectives: this study aims to characterize mechanical properties of ascending aorta (AA) in patients, with and without aortic dissection.

Materials and methods : comprised an in vivo and ex vivo studies performed in 2 groups of patients : (1) patients admitted for acute type A dissection and treated with surgical procedure ; (2) healthy control group selected among patients without any ascending aorta pathology and who underwent transoesophageal echocardiography for various indications.

In vivo study : Strain, distensibility, stiffness index and pressure strain elastic modulus (Ep) were calculated from aortic diameter variation in response to pressure variation. Aortic diameters were measured using transoesophageal echocardiography.

Ex vivo study : biaxial tensile testing were performed on aortic wall samples. Dissected aortic samples were collected from patients who underwent surgical repair and healthy samples from unused donors hearts and lungs. Mechanical characterization was combined to a histological and microstructural analysis of aortic wall. The latter was conducted using multiphoton microscopy to visualize elastin and collagen fibers.

Results :

In vivo study: 22 patients in healthy control group and 13 patients in dissection group were prospectively investigated.

In vitro study : Biaxial testing was performed on 4 samples of dissected aorta and 6 samples of non dissected aorta. Anisotropic and non linear behavior of aortic tissue was shown in the 2 types of samples. Dissected tissue were stiffer than the intimal flap which was in turn stiffer than non dissected tissue.

Histological data showed that in dissection group global elastin density was lower than in control. Microstructural analysis in dissection specimens revealed a higher collagen signal in the media mainly in circumferential plane, contrasting with a roughly similar intensity between the two planes in control. This higher signal reflects higher collagen fiber density and/or thicker fibers in this tunica.

Conclusion : Both in vivo and in vitro data revealed that dissected aorta was stiffer than healthy ascending aorta. These findings has consequences on the choice of futur devices dedicated to AA


Recruitment information / eligibility

Status Recruiting
Enrollment 90
Est. completion date August 2016
Est. primary completion date January 2016
Accepts healthy volunteers No
Gender Both
Age group 50 Years to 85 Years
Eligibility Inclusion Criteria:

- Patients aged 50 to 85 years

- The information given search,

- Aortic dissection evolving for less than 15 days confirmed

Exclusion Criteria:

- the acute aortic dissections against-indicated for aortic surgery (patient age, stroke or multiple organ failure)

- Iatrogenic dissections,

- Dissections related to congenital or hereditary disorder (abnormal connective tissue) or those occurring in subjects with a bicuspid aortic valve,

- Intramural hematomas type A,

- Patients under guardianship or trusteeship deprived of liberty.

Study Design

Time Perspective: Prospective


Related Conditions & MeSH terms


Intervention

Other:
measure the elastic properties of aortic wall


Locations

Country Name City State
France Assistance Publique Hôpitaux de Marseille Marseille

Sponsors (1)

Lead Sponsor Collaborator
Assistance Publique Hopitaux De Marseille

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary measure the elastic properties of aortic wall The distensibility, aortic strain will be measured as a function of changes of aortic diameter and pulse pressure. one day No
Primary Measurement of aortic diameters The measurement will be done by transesophageal echocardiography simultaneously to the cuff brachial artery pressure. one day No
See also
  Status Clinical Trial Phase
Recruiting NCT03894033 - Post-market Registry of the AMDS for the Treatment of Acute DeBakey Type I Dissection