Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Influences of Geometric Configurations of Bypass Grafts on Hemodynamics in End-to-Side Anastomosis

  • Choi, Jae-Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Boramae Hospital) ;
  • Hong, Sung-Chul (Division of Food Bioscience and Technology, Korea University) ;
  • Kwon, Hyuck-Moon (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Suh, Sang-Ho (Department of Mechanical Engineering, College of Engineering, Soongsil University) ;
  • Lee, Jeong-Sang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Boramae Hospital)
  • Received : 2011.02.22
  • Accepted : 2011.03.17
  • Published : 2011.04.05
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Abstract

Background: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. Materials and Methods: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of $45^{\circ}$, $60^{\circ}$ and $90^{\circ}$. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. Results: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. Conclusion: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.

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References

  1. Bassiouny HS, White S, Glagov S, Choi E, Giddens DP, Zarins CK. Anastomotic intimal hyperplasia: mechanical injury or flow induced? J Vasc Surg 1992;15:708-17. https://doi.org/10.1016/0741-5214(92)90019-5
  2. Hofer M, Rappitsch G, Perktold K, Trubel W, Schima H. Numerical study of wall mechanics and fluid dynamics in end-to-side anastomosis and correlation to intimal hyperplasia. J Biomech 1996;29:1297-308. https://doi.org/10.1016/0021-9290(96)00036-X
  3. Ballyk PD, Walsh C, Butany J, Ojha M. Compliance mismatch may promote graft-artery intimal hyperplasia by altering suture-line stresses. J Biomech 1998;31:229-37.
  4. Leuprecht A, Perktold K, Prosi M, Berk T, Trubel W, Schima H. Numerical study of hemodynamics and wall mechanics in distal end-to-side anastomoses of bypass grafts. J Biomech 2002;35:225-36. https://doi.org/10.1016/S0021-9290(01)00194-4
  5. Nerem RM. Vascular fluid mechanics, the arterial wall and atherosclerosis. J Biomech Eng 1992;114:274-82. https://doi.org/10.1115/1.2891384
  6. Texon M, Imparato AM, Helpern M. Role of vascular dynamics in the development of atherosclerosis. JAMA 1965;194:168-72. https://doi.org/10.1001/jama.1965.03090260078039
  7. Fry DL. Response of the arterial wall to certain physical factors in atherogenesis: initiating factors. Ciba Found Symp 1973;12:187-204.
  8. Caro CG, Nerem RM. Transport of C-40-cholesterol between serum and wall in the perfused dog common carotid artery. Circ Res 1973;24:187-204.
  9. John LC. Biomechanics of coronary artery and bypass graft disease: potential new approaches. Ann Thorac Surg 2009;87:331-8. https://doi.org/10.1016/j.athoracsur.2008.07.023
  10. Friedman MH, Brinkman AM, Qin JJ, Seed WA. Relation between coronary artery geometry and the distribution of early sudophilic lesions. Atherosclerosis 1993;98:193-9. https://doi.org/10.1016/0021-9150(93)90128-H
  11. Friedman MH, Baker PB, Ding Z, Kuban BD. Relationship between the geometry and quantitative morphology of the left anterior descending artery. Atherosclerosis 1996;125:183-92. https://doi.org/10.1016/0021-9150(96)05869-8
  12. Friedman MH, Ding Z. Relation between the structural asymmetry of coronary branch vessels and the angle at their origin. J Biomech 1998;31:273-8.
  13. Inzoli F, Migliavacca F, Pennati G. Numerical analysis of steady flow in aorto-coronary bypass 3-D model. J Biomech Eng 1996;118:172-9. https://doi.org/10.1115/1.2795956
  14. Henry FS, Collins MW, Hughes PE, How TV. Numerical investigation of steady flow in proximal and distal end-to-side anastomosis. J Biomech Eng 1996;118:302-10. https://doi.org/10.1115/1.2796011
  15. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulatioin 1998;97:916-31. https://doi.org/10.1161/01.CIR.97.9.916
  16. Dilley RJ, McGeachie JK, Tennant M. Vein to artery grafts: a morphological and histochemical study of the histogenesis of intimal hyperplasia. Aust N Z J surg 1992;62:297-303. https://doi.org/10.1111/j.1445-2197.1992.tb07560.x
  17. Abbott WM, Megerman J. Does compliance mismatch alone cause neointimal hyperplasia? J Vasc Surg 1989;9:507.
  18. Imparato AM, Bracco A, Kim GE, Zeff R. Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions. Surgery 1972;72:1007-17.
  19. Faulkner SL, Fisher RD, Conkle DM, Page DL, Bender HW Jr. Effect of blood flow rate on subendothelial proliferation in venous autografts used as arterial substitutes. Circulation 1975;52:1163-72.
  20. Krams R, Wentzel JJ, Oomen JAF, et al. Evaluation of endothelial shear stress and 3D geometry as factors determining the development of atherosclerosis and remodeling in human coronary arteries in vivo. Arterioscler ThrombVasc Biol 1997;17:2061-5. https://doi.org/10.1161/01.ATV.17.10.2061
  21. Gibson CM, Diaz L, Kandarpa K. Relation of vessel wall shear stress to atherosclerosis progression in human coronary arteries. Arterioscler Thromb 1993;13:310-5. https://doi.org/10.1161/01.ATV.13.2.310
  22. Levesque MJ, Liepsch D, Moravec S, Nerem RM. Correlation of endothelial cell shape and wall shear stress in a stenosed dog aorta. Arteriosclerosis 1986;6:220-9. https://doi.org/10.1161/01.ATV.6.2.220
  23. Glagov S, Zarins C, Giddens DP, Ku DN. Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. Arch Pathol Lab Med 1988;112: 1018-31.
  24. Perktold K, Leuprecht A, Prosi M, et al. Fluid dynamics, wall mechanics, and oxygen transfer in peripheral bypass anastomoses. Ann Biomed Eng 2002;30:447-60. https://doi.org/10.1114/1.1477445
  25. Salzar RS, Thubrikar MJ, Eppink RT. Pressure-induced mechanical stress in the carotid artery bifurcation: a possible correlation to atherosclerosis. J Biomech 1995;28:1333-40. https://doi.org/10.1016/0021-9290(95)00005-3
  26. Taylor WR. Mechanical deformation of the arterial wall in hypertension: a mechanism for vascular pathology. Am J Med Sci 1998;316:156-61. https://doi.org/10.1097/00000441-199809000-00002
  27. Chello M, Mastroroberto P, Frati G, et al. Pressure distension stimulates the expression of endothelial adhesion molecules in the human saphenous vein graft. Ann Thorac Surg 2003;76:453-8. https://doi.org/10.1016/S0003-4975(03)00433-8
  28. Predel HG, Yang Z, von Segesser L, Turina M, Buhler FH, Luscher TF. Implication of pulsatile stretch on growth of saphenous vein and mammary artery smooth muscle. Lancet 1992;340:878-9. https://doi.org/10.1016/0140-6736(92)93287-W
  29. Freshwater IJ, Morsi YS, Lai T. The effect of angle on wall shear stresses in a LIMA to LAD anastomosis: numerical modelling of pulsatile flow. Proc Inst Mech Eng 2006;220:743-57. https://doi.org/10.1243/09544119JEIM126

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