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Related Experiment Videos

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
PubMed
Summary

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This summary is machine-generated.

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.
Keywords:
acute type A aortic dissectionswirling flowtwo‐way fluid–structure interactionwall shear stress

Related Experiment Videos

  • 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.