Comparative Review of Large Animal Models for Suitability of Proximal Aortic Endovascular Repair

Authors

  • Abhishekh Srinivas BMedSc/MD. Department of Surgery, Monash University, School of Clinical Sciences at Monash Health, Monash Medical Centre, Melbourne, Australia. https://orcid.org/0000-0002-3190-3021
  • Ming Yii MBBS, FRACS (Vascular), MPH. Department of Surgery, Monash University, School of Clinical Sciences at Monash Health, Monash Medical Centre, Melbourne, Australia. https://orcid.org/0000-0003-1166-573X
  • Julian A. Smith MBBS, MS, FRACS (Cardiothoracics), FAICD. Department of Surgery, Monash University, School of Clinical Sciences at Monash Health, Monash Medical Centre, Melbourne, Australia. https://orcid.org/0000-0003-1244-4277

DOI:

https://doi.org/10.5195/ijms.2022.763

Keywords:

Aortic dissection, Endovascular, Ascending aorta, Animal models

Abstract

The advent of thoracic endovascular aortic repair (TEVAR) heralds a paradigm shift in treating descending aortopathies. TEVAR is viewed as a potential option for ascending aortic dissection (AD) repair. Currently, TEVAR’s use in treating ascending aortopathies remains limited. Appropriate animal models are urgently needed to improve our understanding of the endovascular treatment of ascending ADs, also known as Stanford Type-A ADs. This narrative review provides a current literature summary on the subject, including the gross anatomical differences among adult porcine, ovine, and bovine species, compared with those of their human counterparts, as well as specific valvular and coronary vasculature measurement variances. An electronic search of Cochrane Library, PubMed, and Ovid Medline databases from January 1965 to June 2020 was performed. The search was limited to articles published in English. Twenty-three research papers were included in this review. Our findings revealed that whereas macroscopic anatomy remains grossly similar among these species, differences in valvular leaflet shape are present, with porcine and ovine models possessing anatomic characteristics that are comparable to their human counterparts. Inter-species differences concerning the anatomy of the ascending aorta have not been extensively studied, highlighting a literature gap. Conversely, multiple morphological studies have highlighted that porcine coronary vasculature is similar to that of humans. In conclusion, both porcine and ovine species are suitable as appropriate animal models for examining the feasibility of endovascular stent-grafts for ascending ADs. However, given the similarities in coronary and aortic valve anatomy with humans, porcine models are better suited for this purpose.

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References

Cesarovic N, Lipiski M, Falk V, Emmert M. Animals in cardiovascular research: Clinical relevance and translational limitations of animal models in cardiovascular medicine. EHJ. 2020;41(2):200-3.

Criado F. Aortic Dissection: A 250-Year Perspective. Tex Heart Inst J. 2011; 8(6):694-700.

Fujimura N, Kawaguchi S, Obara H, Yoshitake A, Inoue M, Otsubo S et al. Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients. Circ J. 2017;81:1388–94.

Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg. 2016;5(4):275-95.

Scholl F, Coady M, Davies R. Interval or Permanent Nonoperative Management of Acute Type A Aortic Dissection. JAMA Surgery. 1999; 134(4):402-6.

Auer J, Berent R, Eber B. Aortic Dissection: Incidence, Natural History and Impact of Surgery. Journal of Clinical and Basic Cardiology. 2000;3(3),151-4.

Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation 1995;92(2):113.

Becker H, Jauch K. Vascular Surgery. 1st Edition. Berlin: Springer-Verlag; 1989. p. 349-60

Shah A, Khoynezhad A. Thoracic endovascular repair for acute type A aortic dissection: operative technique. Ann Cardiothorac Surg. 2016;5(4):389-96.

Kreibich M, Rylski B, Kondov S, Morlock J, Scheumann J, Kari F et al. Endovascular treatment of acute Type A aortic dissection—the Endo Bentall approach. J Vis Surg. 2018;1(4):69.

Heilmann C, Stahl R, Schneider C, Sukhodolya T, Siepe M, Olschewski M et al. Wound complications after median sternotomy: a single-centre study. Interact Cardiovasc Thorac Surg. 2013;16(5):643-8.

Luciani G, Lucchese G. Minimal-access median sternotomy for aortic valve replacement. J Thorac Dis. 2013;5(Suppl 6):S650–3.

Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017;61(9):760–7.

Zanotti G, Reece TB, Aftab M. Aortic Arch Pathology: Surgical Options for the Aortic Arch Replacement. Cardiol Clin. 2017;35(3):367-85.

Nordon IM, Hinchliffe RJ, Morgan R, Loftus IM, Jahangiri M, Thompson MM. Progress in endovascular management of type A dissection. Eur J Vasc Endovasc Surg. 2012;44(4):406-10.

Kreibich M, Soekeland T, Beyersdorf F, Bavaria J, Schröfel H, Czerny M et al. Anatomic feasibility of an endovascular valve–carrying conduit for the treatment of type A aortic dissection. J Thorac Cardiovasc Surg. 2019;157(1):26-34.e1.

Harky A, Al-Adhami A. Stenting in type A aortic dissection: fantasy or reality? J Vis Surg. 2018;4(161):1-3.

Mangialardi N, Serrao E, Ronchey S, Kasemi H, Orico M. Endovascular Treatment of Type A Dissections. Endovascular Today. 2013 Nov. Available from: https://evtoday.com/articles/2013-nov/endovascular-treatment-of-type-a-dissections

University of Minnesota. Comparative Anatomy of the Valves. Available from: http://www.vhlab.umn.edu/atlas/comparative-anatomy-tutorial/external-anatomy.shtml. Last updated [Jan 14,2019]; cited [Jan 20,2020].

Sands M, Rittenhouse E, Mohri H, Merendino K. An Anatomical Comparison of Human, Pig, Calf, and Sheep Aortic Valves. Ann Thorac Surg. 1969;8(5):407-14.

University of Minnesota. Comparative Anatomy of the Valves. Available from: http://www.vhlab.umn.edu/atlas/comparative-anatomy-tutorial/valves.shtml. Last updated Jan 14,2019; cited Jan 20,2020.

Wang C, Lachat M, Regar E, von Segesser L, Maisano F, Ferrari E. Suitability of the porcine aortic model for transcatheter aortic root repair. Interact Cardiovasc Thorac Surg. 2017;26(6):1002-8.

Tao L, Xianhao B, Yuxi Z, Ziwen L, Ziyi X, Zhaoxiang Z et al. Thoracic aortic computed tomography angiography in porcine: establishment of a baseline for endovascular evaluation of the ascending aorta. Interact Cardiovasc Thorac Surg. 2020:31(2):248-53

Khan S, Islam M. Studies on the Prospect of Bioprostheses by Bovine Aortic Valve for Human Use. Bangladesh Med Res Counc Bull. 1991;17(2):75-80

Hyun Joh J, Ahn H, Park H. Reference Diameters of the Abdominal Aorta and Iliac Arteries in the Korean Population. Yonsei Med J. 2013;54(1):48-54.

Jonker F, Mojibian H, Schlösser F, Botta D, Indes J, Moll F et al. The Impact of Hypovolaemic Shock on the Aortic Diameter in a Porcine Model. Eur J Vasc Endovasc Surg. 2010;40(1):564-71.

DiVincenti L, Westcott R, Lee C. Sheep (Ovis aries) as a Model for Cardiovascular Surgery and Management before, during, and after Cardiopulmonary Bypass J Am Assoc Lab Anim Sci. 2014;53(5):439-48.

Dumfarth J, Chou A, Ziganshin B, Bhandari R, Peterss S, Tranquilli M et al. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015;149(6):1586-92.

Layton K, Kallmes D, Cloft H, Lindell E, Cox V. Bovine Aortic Arch Variant in Humans: Clarification of a Common Misnomer. AJNR Am J Neuroradiol. 2006;27(7):1541-2.

Torad F, Amer M, Shamaa A, Elsherpieny E. Echocardiographic measurements and indices in normal adult buffalo (Bubalus bubalis). Journal of Applied Animal Research. 2016;45(1):336-41.

Devereux R, Simone G, Arnett D, Best L, Boerwinkle E, Howard B et al. Normal Limits in Relation to Age, Body Size and Gender of Two- Dimensional Echocardiographic Aortic Root Dimensions in Persons ?15 Years of Age. Am J Cardiol. 2012;110(8):1189-94.

Braun U, Schweizer T. Determination of Heart Dimensions in Cattle via 2-D-mode Echocardiography. Berl Munch Tierarztl Wochenschr. 2001;114(2):46-50.

Sahni D, Kaur G, Jit H, Jit I. Anatomy & Distribution of Coronary Arteries in Pig in Comparison With Man. Indian J Med Res. 2008;127(6):564-70/

Weaver M, Pantely G, Bristow J, Ladley H. A Quantitative Study of the Anatomy and Distribution of Coronary Arteries in Porcine in Comparison With Other Animals and Man. Cardiovasc Res. 1986;20(12):907-17.

Gómez F, Ballesteros L. Evaluation of coronary dominance in pigs; a comparative study with findings in human hearts. Arq. Bras. Med. Vet. Zootec. 2015;67(3):783-9.

Frink R, Merrick B. The Sheep Heart: Coronary and Conduction System Anatomy With Special Reference to the Presence of an Os Cordis. Anat Rec. 1974;179(2):189-200.

Scansen B. Coronary Artery Anomalies in Animals. Vet. Sci. 2017;4(2):20.

Barszcz K, Polguj M, Kle?kowska-Nawrot J, Go?dziewska-Har?ajczuk K, Olbrych K, Czopowicz M. Morphometry and topography of the coronary ostia in the European bison. Folia Morphol. 2019;79(1):105-12.

Gómez F, Cortés L, Ballesteros L. Morphological characterisation of the coronary arteries in African sheep (Ovis orientalis). Differential analysis with those of humans and other animal species. Folia Morphol. 2018;78(1):63-70.

Pham T, Martin C, Elefteriades J, Sun W. Biomechanical characterisation of ascending aortic aneurysm with concomitant bicuspid aortic valve and bovine aortic arch. Acta Biomater. 2013;9(8):7927-36.

Ho S. Structure and anatomy of the aortic root. Eur J Echocardiogr. 2009;10(1):3-10

Published

2022-04-25 — Updated on 2022-07-12

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How to Cite

Srinivas, A., Yii, M., & Smith, J. A. (2022). Comparative Review of Large Animal Models for Suitability of Proximal Aortic Endovascular Repair. International Journal of Medical Students, 10(2), 185–191. https://doi.org/10.5195/ijms.2022.763 (Original work published June 30, 2022)

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Review