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Virtual Planning and Patient-Specific Graft Design for Aortic Repairs
Seda Aslan1, Xiaolong Liu2,3, Qiyuan Wu2
1Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA. saslan2@jhu.edu.
Cardiovascular Engineering and Technology
|November 20, 2023
Summary
Comprehensive repair of coarctation of the aorta (CoA) and transverse arch hypoplasia (TAH) shows better long-term outcomes than isolated CoA repair. Patient-specific simulations aid in planning optimal aortic arch repairs.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Medical Imaging
Background:
- Coarctation of the aorta (CoA) often co-exists with transverse arch hypoplasia (TAH).
- Isolated CoA repair may lead to suboptimal hemodynamics if TAH is untreated.
- Predicting surgical outcomes for combined CoA and TAH is crucial.
Purpose of the Study:
- To develop a patient-specific framework for surgical planning.
- To predict and assess outcomes for simple CoA repair versus comprehensive CoA and TAH repair.
Main Methods:
- Utilized virtual clamp placement, stenosis resection, and patient-specific aortic graft design.
- Employed computational fluid dynamics (CFD) simulations with patient-specific flow data.
- Optimized graft design using parameterized surfaces and CFD analysis for six patients.
Main Results:
- Comprehensive repair improved peak systolic pressure drop by 44% compared to 28% for isolated CoA repair.
- Time-averaged wall shear stress decreased by 60% after CoA repair, with a further 22% improvement after comprehensive repair.
- Oscillatory shear index values remained within the normal range post-repair.
Conclusions:
- Comprehensive repair of CoA and TAH offers superior long-term hemodynamic benefits over isolated CoA repair.
- Patient-specific surgical planning and CFD simulations can influence repair selection and improve outcomes.
- This framework provides a valuable tool for optimizing aortic arch reconstructions.
