No abstract

SUMMARYIn this paper, the commercial CFD package Ansys workbench 11 was used to analyse the three-dimensional haemodynamics of a typical stenotic Coronary Artery Bypass Grafting (CABG). Two end-to-side CABG configurations with anastomosis angle of 20 • and 40 • and graft-artery diameter ratios of 1/0.6, 1/1 and 1/1.6 were examined. The flow measurements from in vitro Doppler guide wire technique acquired in left interior mammary artery (LIMA) and grafted to the left anterior descending artery (LAD) were used to impose the physiologically flow conditions at proximal and distal CABG inlet and outlet, respectively. The blood flow was considered to be incompressible, pulsatile, Newtonian, and laminar rheology. The main objective was to determine the effect of anastomosis angle and graft-artery diameter ratio on the flow patterns and the long-term functionality of the graft. In analysing the results, the distributions of temporal and spatial wall shear stress (WSS) gradient and oscillating shear index (OSI) in the critical regions of CABG such as heel, toe and the centre of the junction were presented and the vortex motions and the occurrence of recirculation zones were examined. The findings showed asymmetrically disturbed flows in the localized regions of the proximal and distal host artery for all models considered and the movement of the recirculation zones from heel to toe was found to depend on the time at the cardiac cycle. These regions are known as susceptible sites to thrombosis and re-stenosis due to their association with low values of WSS.

In this article, particle image velocimetry (PIV) technique was used to determine the instantaneous velocity fields inside a model of end-to-side anastomosis under various physiological flow conditions. Using ANSYS software, a three-dimensional (3D) computational model at the peak systolic blood flow was simulated. The numerical and experimental results were presented and discussed in terms of velocity fields at various locations along the graft and the host artery. The numerical results were then compared with the experimental data and a large difference was found, which was attributed to the imperfection of manufacturing the glass model and measurements error associated with PIV. The findings indicated in general that the analysis at peak systole, steady flow could help in providing essential quantitative information of the hemodynamics in anastomotic artery.

The progression of intimal hyperplasia is considered to be the main cause of bypass failure and is directly related to the individual blood rheology, local arterial geometry and placement of the junctions, graft diameter and graft surface characteristics as well as the degree of compliance. In this paper we use commercial computational fluid dynamics (CFD) ANSYS to examine under the correct physiological flow conditions the hemodynamic forces of composite bypass with internal mammary artery in Y-grafting and consequence grafting which is known to achieve high patency rate and highly recommended by clinicians. Particular emphasis is given here on the parameters that could initiate the development of intimal hyperplasia within these bypass configurations. The hemodynamic flow patterns between the consequence grafting and the composite Y-grafting are observed here to be different. Moreover, on both end-to-side and side-to-side configurations, the circulating flows are detected in the vicinity of the junction area, while the Dean flow vortexes are only observed on the end-to-side configuration. Likewise, the hemodynamic flow on the end-to-side configuration on the LCX of both 45° and 90° Y-grafting is found to be smoother than that of the junction on the LCA, regardless of the changing of anastomosis angles. The high WSS gradients are observed at the vicinity of the toe and on the bed of the junction, while the low WSS are presented at the distal of the stenosis and at the stagnation point. The clinical relevance of the results are presented and discussed with particular focus on the factors and the flow patterns that trigger the development of intimal hyperplasia.

Designing and manufacturing of vascular prosthesis for arterial bypass grafts is a very complex problem. The process involves the selection of suitable geometry, materials of appropriate characteristics, and manufacturing technique capable of constructing prosthesis in a cost-effective manner. In this chapter, all engineering aspects related to the design and optimization of an artificial graft are presented and discussed. These aspects include CAD design of the graft, in vitro hemodynamic analysis to ensure good mechanical integrity and functionality, and optimization of the manufacturing techniques. Brief discussion is also given on the endothelization and vascularization of the artificial vessels and the future directions of the development of synthetic vessels for human implementation.