Abstract 17236: Computational Blood Flow Analysis of the Aortic Arch and the Neck Vessels: Total Arch Replacement vs Stent Graft With Neck Vessel Debranching
Introduction: It is unclear how blood flow inside the aortic arch and neck vessels changed after arch reconstruction.
Hypothesis: Computational fluid dynamics (CFD) analysis could demonstrate blood flow details of arch vessels post total neck vessels debranching with thoracic endovascular aortic repair (TD-TEVAR) and total arch replacement.
Methods: We created 8 patient-specific aortic arch models from pre and post-operative computed tomographic images of 4 patients with arch aneurysm who underwent TD-TEVAR. Virtual total arch replacement simulation model was created from preoperative image of each clinical case using 3D CG software. CFD models with finite volume methods were created to simulate physiological pulsatile flow including peripheral reflection wave, characteristic impedance and autonomous regulation system. Flow stream patterns of 12 models were calculated to assess the difference of blood flow in the neck vessels. Blood flow energy loss of each model was calculated to estimate cardiac workload.
Results: Average of calculated blood flow distribution of the innominate artery (IA), left carotid artery (CA), left subclavian artery (SCA), and descending artery of the native aortic arch, post TD-TEVAR and virtual total arch replacement model are shown in the table. With the stable cardiac output, the blood flow in each neck vessel was estimated to decrease after TD-TEVAR or virtual total arch replacement, compared with native aortic arch, by 24.5% and 15.9% in IA (p=0.21), 48.0% and minus 1.6% (increased) (p=0.002) in CA, and 35.3% and 5.6% (p=0.06) in SCA. Calculated flow energy loss of native aortic arch was 7.8 ± 4.0 mW, which was demonstrated to increase to 14.1 ± 2.6 mW with TD-TEVAR, and 11.9 ± 4.5 mW with virtual total arch replacement.
Conclusions: Total arch replacement may be superior to TD-TEVAR with regard to neck vessels blood flow especially in CA. The arch shape of TD-TEVAR could require more cardiac workload than that of total arch replacement.
Author Disclosures: T. Horai: None. T. Kitamura: None. S. Torii: None. K. Sughimoto: None. K. Kobayashi: None. Y. Irisawa: None. H. Hayashi: None. T. Matsushiro: None. Y. Tsuchida: None. Y. Miyata: None. K. Miyaji: None.
- © 2016 by American Heart Association, Inc.