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Total Arch Replacement Versus Hemiarch Replacement in Hemodynamic Performance: A Simulation Study
Yike Shi1, Chenjia Zhang1, Yawei Zhao1
1Department of Biomedical Engineering, College of Artificial Intelligence, Taiyuan University of Technology, Taiyuan, Shanxi, China.
International Journal for Numerical Methods in Biomedical Engineering
|February 20, 2025
Summary
Hemiarch replacement (HAR) increases pseudoaneurysm risk, while total arch replacement (TAR) raises risks of limb and brain ischemia after acute type A aortic dissection surgery. Personalized in silico analysis guides better patient management.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Computational Fluid Dynamics
Background:
- Acute type A aortic dissection (ATAAD) is a critical condition with high mortality.
- Hemiarch replacement (HAR) and total arch replacement (TAR) are standard surgical treatments for ATAAD.
- Long-term outcomes of HAR versus TAR are debated, potentially due to confounding clinical factors in multicenter studies.
Purpose of the Study:
- To evaluate the long-term outcomes of HAR and TAR for ATAAD using in silico analysis.
- To mitigate the influence of clinical factors by employing computational modeling.
- To compare hemodynamic and wall response parameters between HAR and TAR simulations.
Main Methods:
- Personalized computational models were reconstructed to simulate HAR and TAR procedures.
- Material properties at replacement regions were altered to mimic surgical interventions.
- Two-way fluid-structure interaction analysis was performed to obtain hemodynamic and wall response parameters.
Main Results:
- Hemiarch replacement (HAR) showed a significantly higher increase in von Mises stress at the anastomosis (4.39 times normal) compared to total arch replacement (TAR) (2.42 times normal).
- TAR simulations indicated more severe streamline absence in arch branches, suggesting potential intermittent blood flow to the brain and upper limbs.
- HAR simulation results suggest an increased risk of pseudoaneurysm formation at the anastomosis.
Conclusions:
- Hemiarch replacement (HAR) poses a higher risk of pseudoaneurysm formation at the anastomosis.
- Total arch replacement (TAR) is associated with increased risks of upper limb and cerebral ischemia.
- Enhanced postoperative monitoring and vigilance are recommended for patients undergoing HAR and TAR, respectively, to prevent complications and improve quality of life.
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