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Patient-Specific Hemodynamics of New Coronary Artery Bypass Configurations

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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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Authors and Affiliations

  1. Department of Mechanical Engineering, Koc University, Rumeli Feneri Campus, Sariyer, Istanbul, Turkey

    Mohammad Rezaeimoghaddam, Gokce Nur Oguz, S. Samaneh Lashkarinia & Kerem Pekkan

  2. Department of Cardiovascular Surgery, Koc University Hospital, Topkapi, Istanbul, Turkey

    Mehmet Sanser Ates & Tijen Alkan Bozkaya

  3. Department of Mechanical Engineering, Istinye University, Zeytinburnu, Istanbul, Turkey

    Senol Piskin

  4. Department of Cardiology, Health Sciences University, Bursa Education and Research Hospital, Bursa, Turkey

    Erhan Tenekecioglu

  5. Department of Cardiovascular Surgery, VKV American Hospital, Istanbul, Turkey

    Haldun Karagoz

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  1. Mohammad Rezaeimoghaddam
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Correspondence to Kerem Pekkan.

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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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