Patient-specific computational simulation of coronary artery bypass grafting

Abstract

Introduction Coronary artery bypass graft surgery (CABG) is an intervention in patients with extensive obstructive coronary artery disease diagnosed with invasive coronary angiography. Here we present and test a novel application of non-invasive computational assessment of coronary hemodynamics before and after bypass grafting. Methods and results We tested the computational CABG platform in n = 2 post-CABG patients. The computationally calculated fractional flow reserve showed high agreement with the angiography-based fractional flow reserve. Furthermore, we performed multiscale computational fluid dynamics simulations of pre- and post-CABG under simulated resting and hyperemic conditions in n = 2 patient-specific anatomies 3D reconstructed from coronary computed tomography angiography. We computationally created different degrees of stenosis in the left anterior descending artery, and we showed that increasing severity of native artery stenosis resulted in augmented flow through the graft and improvement of resting and hyperemic flow in the distal part of the grafted native artery. Conclusions We presented a comprehensive patient-specific computational platform that can simulate the hemodynamic conditions before and after CABG and faithfully reproduce the hemodynamic effects of bypass grafting on the native coronary artery flow. Further clinical studies are warranted to validate this preliminary data.

Hemodynamics and Wall Mechanics of Vascular Graft Failure

“…The role of hemodynamics in SVG failure has suggested the use of patient-specific CFD models to plan surgeries with better initial conditions, such as by leveraging changes in anastomosis position, diameter, and graft type to control average and local WSS. 163,164 Given donor site morbidity following harvest of autologous vessels and that synthetic grafts have tunable mechanical properties, numerous experiments have examined the use of prosthetic conduits for CABG. Despite their promise in large-caliber vessels, small-diameter synthetic grafts experience high rates of acute thrombogenicity as they lack a functional endothelium, and high WSS values in smaller diameter grafts can lead to platelet activation and aggregation.…”