Patient-Specific Hemodynamics of New Coronary Artery Bypass Configurations
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Cardiovascular Engineering and Technology ( 2020) https://doi.org/10.1007/s13239-020-00493-9
Original Article
Patient-Specific Hemodynamics of New Coronary Artery Bypass Configurations MOHAMMAD REZAEIMOGHADDAM,1 GOKCE NUR OGUZ,1 MEHMET SANSER ATES,2 TIJEN ALKAN BOZKAYA,2 SENOL PISKIN,3 S. SAMANEH LASHKARINIA,1 ERHAN TENEKECIOGLU,4 HALDUN KARAGOZ,5 and KEREM PEKKAN 1 1 Department of Mechanical Engineering, Koc University, Rumeli Feneri Campus, Sariyer, Istanbul, Turkey; 2Department of Cardiovascular Surgery, Koc University Hospital, Topkapi, Istanbul, Turkey; 3Department of Mechanical Engineering, Istinye University, Zeytinburnu, Istanbul, Turkey; 4Department of Cardiology, Health Sciences University, Bursa Education and Research Hospital, Bursa, Turkey; and 5Department of Cardiovascular Surgery, VKV American Hospital, Istanbul, Turkey
(Received 21 May 2019; accepted 1 October 2020) Associate Editor David Steinman oversaw the review of this article.
Abstract Purpose—This study aims to quantify the patient-specific hemodynamics of complex conduit routing configurations of coronary artery bypass grafting (CABG) operation which are specifically suitable for off-pump surgeries. Coronary perfusion efficacy and local hemodynamics of multiple left internal mammary artery (LIMA) with sequential and end-to-side anastomosis are investigated. Using a full anatomical model comprised of aortic arch and coronary artery branches the optimum perfusion configuration in multi-vessel coronary artery stenosis is desired. Methodology—Two clinically relevant CABG configurations are created using a virtual surgical planning tool where for each configuration set, the stenosis level, anastomosis distance and angle were varied. A non-Newtonian computational fluid dynamics solver in OpenFOAM incorporated with resistance boundary conditions representing the coronary perfusion physiology was developed. The numerical accuracy is verified and results agreed well with a validated commercial cardiovascular flow solver and experiments. For segmental performance analysis, new coronary perfusion indices to quantify deviation from the healthy scenario were introduced. Results—The first simulation configuration set;—a CABG targeting two stenos sites on the left anterior descending artery (LAD), the LIMA graft was capable of 31 mL/min blood supply for all the parametric cases and uphold the healthy LAD perfusion in agreement with the clinical experience. In the second end-to-side anastomosed graft configuration set;—the radial artery graft anastomosed to LIMA, a maximum of 64 mL/min flow rate in LIMA was observed. However,
Address correspondence to Kerem Pekkan, Department of Mechanical Engineering, Koc University, Rumeli Feneri Campus, Sariyer, Istanbul, Turkey. Electronic mail: [email protected]
except LAD, the obtuse marginal (OM) and second marginal artery (m2) suffered poor perfusion. In the first set, average wall shear stress (WSS) were in the range of 4 to 35 dyns/cm2 for in LAD. Nevertheless, for second configuration sets the WSS values were higher as the
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