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, 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 LIMA could not supply enough blood to OM and m2.
Conclusion
The virtual surgical configurations have the potential to improve the quality of operation by providing quantitative surgical insight. The degree of stenosis is a critical factor in terms of coronary perfusion and WSS. The sequential anastomosis can be done safely if the anastomosis angle is less than 90 degrees regardless of degree of stenosis. The smaller proposed perfusion index value, O(0.04 − 0) × 102, enable us to quantify the post-op hemodynamic performance by comparing with the ideal healthy physiological flow.
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Abbreviations
- CABG:
-
Coronary artery bypass grafting
- CAD:
-
Coronary artery diseases
- CEP:
-
Cerebral perfusion index
- CFD:
-
Computational fluid dynamics
- COP:
-
Coronary perfusion index
- CT:
-
Computed tomography
- IA:
-
Innominate artery
- IH:
-
Intimal hyperplasia
- LAD:
-
Left anterior descending
- LCCA:
-
Left common carotid artery
- LCX:
-
Left circumflex artery
- LIMA:
-
Left internal mammary artery
- LOP:
-
Lower Body Perfusion Index
- LSA:
-
Left subclavian artery
- OM:
-
Obtuse marginal
- m2:
-
Second marginal artery
- PCI:
-
Percutaneous coronary intervention
- RA:
-
Radial artery
- RCA:
-
Right coronary artery
- RM:
-
Ramus marginalis
- s1:
-
First septal artery
- sec:
-
Section
- VA:
-
Vertebral artery
- WSS:
-
Wall shear stress
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Acknowledgments
Funding is provided by grants from the European Research Council (ERC) Proof of Concept Grant KidsSurgicalPlan and the TUBITAK 1003 priority-research Program Grant 115E690.
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Rezaeimoghaddam, M., Oguz, G.N., Ates, M.S. et al. Patient-Specific Hemodynamics of New Coronary Artery Bypass Configurations. Cardiovasc Eng Tech 11, 663–678 (2020). https://doi.org/10.1007/s13239-020-00493-9
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DOI: https://doi.org/10.1007/s13239-020-00493-9