Aortic Remodeling After Total Endovascular Aortic Repair With Multilayer Stents: Computational Fluid Dynamics Analysis of Aortic Remodeling Over 3 Years of Follow-up

Abstract

To report Multilayer Flow Modulator (MFM) implantation from the sinotubular junction to the distal infrarenal aorta in the treatment of type B aortic dissection (TBAD) and demonstrate aortic remodeling using computational fluid dynamics (CFD) analysis over the course of 3-year follow-up. Case Report: A hypertensive patient with complicated TBAD required thoracic endovascular aortic repair due to severe thoracic pain associated with rapid progression of the false lumen aneurysm toward the distal aortic arch. Under general anesthesia, 2 aortic multilayer stents were placed over a 0.035-inch stiff guidewire in the compressed true lumen. The aorta was covered with 2 MFM stents between the sinotubular junction and the distal infrarenal aorta. Serial computed tomography scans showed progressive remodeling of the entire dissected aortic wall, with an excellent result at 24 months. Morphological and CFD vascular analysis confirmed the aortic remodeling, with a false lumen index drop from a preoperative 4.04 to 0.01 at 36 months. Conclusion: Endovascular aortic repair with multilayer stents is a promising treatment for complicated TBAD due to the unique ability of these devices to stabilize the entire aortic wall without compromising the flow in the major aortic side branches.

One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection

“…Morphologic and flow computational fluid dynamics (CFD) simulations were performed by 2 teams of CFD analysts following a standardized aortic dissection protocol as previously published by the current study group. 20 The analysts were not involved in the clinical treatment of the patients and were not informed of the postoperative clinical outcomes. CFD simulations were performed of all CT scans preoperatively and during each follow-up visit for all included patients.…”

“…The anatomical location of this plane varies from one patient to another, being situated at the inferior thoracic level in the majority of patients. 20…”

“…The anatomical location of this plane varies from one patient to another, being situated at the inferior thoracic level in the majority of patients. 20 In Ansys Workbench software (version 18.2; Ansys, Canonsburg, PA, USA), CFD flow models of all cases were compiled to assess flow and remodeling of the lumens before and after endovascular treatment using MFM stents as previously shown. 20 CFD flow models were not quantitatively analyzed; however, they functioned as visualization to support the quantitative measurements.…”

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

“…Blood flow analysis by CFD is an advanced computing simulation tool that can be used to evaluate wall shear stress, stress, flow velocity, flow streamline, helicity index, and other fluid dynamic parameters (15). CFD has developed rapidly in recent years, and has been applied to the fields of medical bioengineering and cardiovascular disease (16). Although there were some studies on the CFD of aortic dissection, most of them focus on the CFD characteristics of the disease model and/or the CFD difference between preoperative and postoperative in type B, and there were few reports on the difference of CFD between different cannulation during CPB (17,18).…”

Multidisciplinary preoperative simulations to optimize surgical outcomes in a challenging case of the complete double aortic arch in the adult

“…3D rapid prototyping simulation is becoming more and more frequent in clinical practice, 6–8 but so far has been used mainly for a better anatomical definition and has, surely, the further potentiality to be explored. Fluid‐dynamic computational analysis, applied so far especially to evaluate postoperative hemodynamic following transcatheter procedures, 9,10 are, on other hands, surely more demanding and time‐spending, but if appropriately applied, could give key data on postoperative results.…”