Association of hemodynamic factors and progressive aortic dilatation following type A aortic dissection surgical repair

Zhu, Yanhe; Mirsadraee, Saeed; Asimakopoulos, George; Gambaro, Alessia; Rosendahl, Ulrich; Pepper, John; Xu, Xiao Yun

doi:10.1038/s41598-021-91079-5

Cited by 24 publications

(30 citation statements)

References 49 publications

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“…Re-intervention in patients with progressive aortic dilatation after surgical repair of TAAD is typically based on aortic size and the rate of expansion. In our previous studies, a systematic examination of the flow patterns and hemodynamic factors in dissected aortas was performed, and possible links were identified between luminal pressure difference and the progression of aneurysmal dilatation ( Zhu et al, 2021 ; Zhu et al, 2022 ). This study presents FSI simulations of two repaired TAAD patients, and the results from the FSI simulations are comprehensively compared with the corresponding CFD results to evaluate the assumption of rigid aortic wall.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous studies have shown that higher pressure difference between TL and FL (PD TL-FL ) may be associated with progressive aortic dilatation in repaired TAAD ( Zhu et al, 2021 ; Zhu et al, 2022 ). However, one major limitation of these studies was that the CFD simulations were based on rigid wall assumptions and thereby assessing the effect of wall compliance on PD TL-FL is of particular interest in this study.…”

Section: Discussionmentioning

confidence: 99%

“…A 3-element windkessel model (3-EWM) was imposed at each outlet. Details of the applied boundary conditions for flow analysis can be found in our previous study ( Zhu et al, 2021 ). Blood was assumed to be incompressible and Newtonian with a constant density of 1,060 kg/m 3 and dynamic viscosity of 0.004 Pa.s.…”

Section: Methodsmentioning

confidence: 99%

“…To prevent sudden aortic rupture and late death, efforts have been made to identify risk factors for aortic dilatation following TAAD repair. In addition to anatomical features, such as maximum aortic diameter and FL patency ( Fattori et al, 2000 ; Halstead et al, 2007 ; Zierer et al, 2007 ; Rylski et al, 2017 ), certain hemodynamic parameters have been reported to correlate with progressive aortic dilatation, including luminal pressure difference between TL and FL ( Zhu et al, 2021 ; Zhu et al, 2022 ) and flow velocities through tears ( Shad et al, 2021 ). However, these hemodynamic parameters were obtained from computational fluid dynamics (CFD) simulations with a rigid wall assumption.…”

Section: Introductionmentioning

confidence: 99%

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Fluid-Structure Interaction Simulations of Repaired Type A Aortic Dissection: a Comprehensive Comparison With Rigid Wall Models

et al. 2022

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This study aimed to evaluate the effect of aortic wall compliance on intraluminal hemodynamics within surgically repaired type A aortic dissection (TAAD). Fully coupled two-way fluid-structure interaction (FSI) simulations were performed on two patient-specific post-surgery TAAD models reconstructed from computed tomography angiography images. Our FSI model incorporated prestress and different material properties for the aorta and graft. Computational results, including velocity, wall shear stress (WSS) and pressure difference between the true and false lumen, were compared between the FSI and rigid wall simulations. It was found that the FSI model predicted lower blood velocities and WSS along the dissected aorta. In particular, the area exposed to low time-averaged WSS (≤0.2 Pa) was increased from 21 cm2 (rigid) to 38 cm2 (FSI) in patient 1 and from 35 cm2 (rigid) to 144 cm2 (FSI) in patient 2. FSI models also produced more disturbed flow where much larger regions presented with higher turbulence intensity as compared to the rigid wall models. The effect of wall compliance on pressure difference between the true and false lumen was insignificant, with the maximum difference between FSI and rigid models being less than 0.25 mmHg for the two patient-specific models. Comparisons of simulation results for models with different Young’s moduli revealed that a more compliant wall resulted in further reduction in velocity and WSS magnitudes because of increased displacements. This study demonstrated the importance of FSI simulation for accurate prediction of low WSS regions in surgically repaired TAAD, but a rigid wall computational fluid dynamics simulation would be sufficient for prediction of luminal pressure difference.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fluid-Structure Interaction Simulations of Repaired Type A Aortic Dissection: a Comprehensive Comparison With Rigid Wall Models

et al. 2022

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“…Additionally, analysis of pressure values can be helpful in the study of aneurysmal dilatation and malperfusion 23 , 38 . A more recent study has shown the importance of TAWSS and pressure difference values between the TL and FL in the prediction of rapid aneurysmal expansion in the dissected aorta 39 , confirming the need for further measuring of hemodynamic metrics for the prediction of further progression and development of AD. Furthermore, a recent review has indicated the importance of CFD tools and hemodynamic features for risk assessment in AD patients, which can be used by clinicians 40 .…”

Section: Introductionmentioning

confidence: 85%

The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

Abazari

Rafieianzab

Soltani

et al. 2021

Sci Rep

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Aortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.

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The Influence of Minor Aortic Branches in Patient-Specific Flow Simulations of Type-B Aortic Dissection

et al. 2023

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Type-B aortic dissection (TBAD) is a disease in which a tear develops in the intimal layer of the descending aorta forming a true lumen and false lumen (FL). Because disease outcomes are thought to be influenced by haemodynamic quantities such as pressure and wall shear stress (WSS), their analysis via numerical simulations may provide valuable clinical insights. Major aortic branches are routinely included in simulations but minor branches are virtually always neglected, despite being implicated in TBAD progression and the development of complications. As minor branches are estimated to carry about 7–21% of cardiac output, neglecting them may affect simulation accuracy. We present the first simulation of TBAD with all pairs of intercostal, subcostal and lumbar arteries, using 4D-flow MRI (4DMR) to inform patient-specific boundary conditions. Compared to an equivalent case without minor branches, their inclusion improved agreement with 4DMR velocities, reduced time-averaged WSS (TAWSS) and transmural pressure and elevated oscillatory shear in regions where FL dilatation and calcification were observed in vivo. Minor branch inclusion resulted in differences of 60-75% in these metrics of potential clinical relevance, indicating a need to account for minor branch flow loss if simulation accuracy is sought.

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Association of hemodynamic factors and progressive aortic dilatation following type A aortic dissection surgical repair

Cited by 24 publications

References 49 publications

Fluid-Structure Interaction Simulations of Repaired Type A Aortic Dissection: a Comprehensive Comparison With Rigid Wall Models

Fluid-Structure Interaction Simulations of Repaired Type A Aortic Dissection: a Comprehensive Comparison With Rigid Wall Models

The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

The Influence of Minor Aortic Branches in Patient-Specific Flow Simulations of Type-B Aortic Dissection

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