Reverse cannulation method as a strategy for aortic aneurysm surgery: A computational fluid dynamics study on...

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Medical Imaging

Background:

• Aortic arch aneurysms present surgical challenges, particularly with "shaggy" aorta.
• Maintaining stable cerebral blood flow during total arch replacement is critical.

Purpose of the Study:

• To evaluate blood flow dynamics and wall shear stress in total aortic arch replacement using computational fluid dynamics.
• To determine the optimal cannulation strategy for "shaggy" aortas.

Main Methods:

• Patient-specific aortic arch models were created from CT scans.
• Three cannula types were simulated with varying tip orientations (standard vs. reversed).
• Computational fluid dynamics analyzed blood flow velocity, streamlines, wall shear stress, and flow distribution.

Main Results:

• Standard cannula direction led to unstable cerebral branch flow due to variable accelerated flow and wall shear stress.
• Reversed cannula direction (toward aortic root) prevented accelerated flow at critical areas, ensuring stable cerebral branch flow.
• Flow distribution showed minimal variation across cannula types and angles in the reversed direction.

Conclusions:

• Cannula tip orientation toward the aortic root is a potentially optimal approach for aortic arch surgery in "shaggy" aorta.
• This reversed direction strategy ensures stable cerebral branch flow irrespective of cannula type or orientation.
• Simulations highlight the importance of cannulation strategy in mitigating hemodynamic risks.