Extracorporeal membrane oxygenation (ECMO) is a vital mechanical circulatory support modality capable of restoring perfusion for the patient in circulatory failure.Despite increasing adoption of ECMO there is incomplete understanding of its effects on systemic hemodynamics and how the vasculature responds to varying levels of continuous retrograde perfusion. To gain further insight into the complex ECMO:failingheart circulation, computational fluid dynamics simulations focused on perfusion distribution and hemodynamic flow patterns were conducted using a patient-derived aorta geometry. Three case scenarios were simulated: (1) healthy control; (2) 90% ECMO-derived perfusion to model profound heart failure; and, (3) 50% ECMO-derived perfusion to model the recovering heart. Fluid-structure interface simulations were performed to quantify systemic pressure and vascular deformation throughout the aorta over the cardiac cycle. ECMO support alters pressure distribution while decreasing shear stress. Insights derived from computational modeling may lead to better understanding of ECMO support and improved patient outcomes.

Compliance mismatch between the graft and the host artery of an end-to-side (ETS) arterial bypass graft anastomosis increases the intramural stress in the ETS graft–artery junction, and thus may compromise its long-term patency. The present study takes into account the effects of collagen fibers to demonstrate how their orientations alter the stresses. The stresses in an ETS bypass graft anastomosis, as a man-made bifurcation, are compared to those of its natural counterpart with different fiber orientations. Both of the ETS bypass graft anastomosis and its natural counterpart have identical geometric and material models and only their collagen fiber orientations are different. The results indicate that the fiber orientation mismatch between the graft and the host artery may increase the stresses at both the heel and toe regions of the ETS anastomosis (the maximum principal stress at the heel and toe regions increased by 72% and 12%, respectively). Our observations, thus, propose that the mismatch between the collagen fiber orientations of the graft and the host artery, independent of the effect of the suture line, may induce aberrant stresses to the anastomosis of the bypass graft.

Disrupted flow initiates and aggravates intimal thickening in the end-to-side (ETS) coronary artery bypass grafting (CABG), which may lead to failure. To enhance the post-intervention hemodynamics, the geometry is either optimized or totally reconfigured. Majority of configurations proposed by researchers have not suited CABG surgery, for they entailed rigorous manipulation on conventional grafts in situ, which was neither swift nor straightforward. The aim of the present study is, thus, to introduce a slight, yet effective, modification to a conventional ETS CABG configuration, and numerically investigate its effects on updated hemodynamic and structural environment, anticipating the longevity of proposed configuration and CABG success. This fairly simple modification may easily be made positioning a pre-designed anastomotic device between the bed of host artery in the conventional ETS CABG and its surrounding tissues. Conducting comprehensive numerical simulations, performance of the proposed configuration was assessed using idealized and patient-specific geometries of the conventional ETS CABG. Blood flow was simulated in a conventional and an updated CABG configuration considering 2-way fluid–structure interaction. Results revealed that, although the proposed configuration may induce higher structural stresses in vessels walls, it may improve important hemodynamic metrics such as wall shear stress gradient, oscillatory shear index, and relative residence time on host artery bed reducing disruption of flow. This study may also set the stage for design engineers and regulatory officials to evolve ETS CABG toward more hemodynamics-friendly approaches. Further in vitro, preclinical, and clinical experiments are, yet, entailed to accomplish ideal designs of procedural guidelines/grafts.