Hemodynamic and biomechanical impact of proximal aortic surgery on the cardiovascular system: a systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Source: Journal of Thoracic Disease
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223568437