Computational fluid dynamics analysis of endoluminal aortic perfusion.

Area of Science:

• Cardiovascular Physiology
• Medical Device Engineering
• Computational Fluid Dynamics

Background:

• Peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) via femoral arteries can lead to inadequate upper body perfusion.
• New long, flexible cannulas allow for improved positioning within the aorta.

Purpose of the Study:

• To investigate the impact of advanced long endoluminal cannula positioning on upper body perfusion during VA-ECMO.
• To compare different cannula positions and support levels using Computational Fluid Dynamics (CFD).

Main Methods:

• Developed idealized and patient-specific aortic models with endoluminal cannulas.
• Simulated blood flow and oxygen saturation at 50% and 90% VA-ECMO support levels.
• Analyzed three distinct cannula positions: ascending aorta, aortic arch, and descending aorta.

Main Results:

• Cannula placement in the ascending aorta provided superior oxygenation to most aortic branches, except the left coronary artery.
• Aortic arch and descending aorta positions supported supra-aortic arteries but not coronary arteries.
• All investigated cannula positions successfully supplied all branches with saturated blood at 90% flow volume.

Conclusions:

• Retrograde advancement of long endoluminal cannulas in VA-ECMO can substantially enhance upper body oxygenation.
• Optimal cannula positioning can achieve oxygen saturation distributions comparable to central cannulation.
• CFD analysis supports clinical observations on improved perfusion with advanced cannula placement.