Computational fluid dynamics simulations of flow distribution and graft designs in apicoaortic bypass
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ORIGINAL ARTICLE
Computational fluid dynamics simulations of flow distribution and graft designs in apicoaortic bypass Takashi Sasaki1 · Hitomi Ueda1 · Keiichi Itatani2 · Kenji Suzuki1 · Jiro Kurita1 · Shun‑ichiro Sakamoto1 · Yasuo Miyagi1 · Yosuke Ishii1 · Tetsuro Morota1 · Takashi Nitta1 Received: 8 May 2020 / Accepted: 16 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective Apicoaortic bypass has double outlets and its graft design is similar to that of a left ventricular assist device (LVAD). The left ventricular apex to the descending aorta (LV-DsAo) bypass is widely used in apicoaortic bypass. In contrast, the left ventricular apex to the ascending aorta (LV-AsAo) bypass is standard in LVAD surgery. This study aimed to evaluate the graft designs of apicoaortic bypass and their effects on flow distribution and energy loss (EL). Methods A simulation study using computational fluid dynamics was performed on the geometry and hemodynamics data obtained from a 30-year-old patient who underwent a LV-DsAo bypass. The ratio of the cardiac output (CO) through the ascending aorta (AsAo) and apicoaortic conduit was set at 50:50, 30:70, and 10:90. Regional blood flow (RBF) and EL were calculated for the different distribution ratios. As an alternative to the LV-DsAo bypass, a virtual LV-AsAo bypass surgery was performed, and each parameter was compared with that of the LV-DsAo bypass. Results At a distribution ratio of 50:50, the RBF to the head and EL were 16.4% of the total CO and 62.0 mW in the LVDsAo bypass, and 32.3% and 81.5 mW in the LV-AsAo bypass, respectively. The RBF to the head decreased with the CO through the AsAo in the LV-DsAo bypass, but it was constant in the LV-AsAo bypass. The EL increased inversely with the CO through the AsAo in both graft designs. Conclusion The regional blood flow distribution was different, but the trend of the EL which increased inversely with the CO through the AsAo was similar between the LV-DsAo and LV-AsAo bypasses. Keywords Apicoaortic bypass · Flow distribution · Graft design · Computational fluid dynamics · Energy loss · Cerebral perfusion
Introduction
Presented at the 71st Annual Scientific Meeting of the Japanese Association for Thoracic Surgery, Oct 2018. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01527-8) contains supplementary material, which is available to authorized users. * Takashi Sasaki t‑[email protected] 1
Department of Cardiovascular Surgery, Nippon Medical School, 1‑1‑5, Sendagi, Bunkyo‑ku, Tokyo 113‑8603, Japan
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
2
The current indication for apicoaortic bypass is limited to a small subset of high-risk patients for whom surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) is not feasible [1]. We performed surgery several times on an adult patient with interrupted aortic arch and left ventricular outflow obstruction
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