Energetic impact of thoracic aortic stenting evaluated in a pulsatile in vitro model

Thoracic endovascular aortic repair (TEVAR) induces a pronounced reduction in aortic compliance, potentially leading to left ventricular hypertrophy (LVH). However, the quantitative energetic penalty imposed on the heart remains unclear. In this study, a controllable pulsatile in vitro circulation loop incorporating a compliant silicone aortic model was developed to experimentally quantify the hemodynamic consequences of stenting. Synchronized pressure and flow measurements enabled the calculation of cardiac work per unit volume and direct comparison between healthy and stented conditions. The results demonstrated that stenting significantly diminished the pressure-buffering capacity of the vessel, resulting in increased systolic pressure and a pronounced pressure-flow phase mismatch. In contrast, healthy vessels maintained smoother flow outputs. Notably, under short-period and high-amplitude pulsations, the work per unit volume in stented models reached 285% and 271% of that in healthy vessels, respectively. These findings indicate that loss of compliance substantially increases the mechanical workload on the heart. This study provides direct experimental evidence that reduced post-TEVAR compliance elevates cardiac energy demand, revealing a mechanistic link between aortic stiffening and LVH.