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Published on: July 19, 2016
Efficacy evaluation and parametric study of the novel concave triple branched stent graft system based on hemodynamic
Xiran Cao1, Yutong Xiao2, Yue Che1
1School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China.
Insights
The concave supra-arch triple branched stent-graft system (CS system) effectively treats aortic arch pathologies by maintaining blood flow to supra-aortic trunks. Patient-specific design, particularly aortic diameter, influences hemodynamic outcomes, guiding optimized treatment strategies.
Area of Science:
- Cardiovascular Engineering
- Medical Device Design
- Hemodynamics
Background:
- Aortic arch pathologies require innovative treatment options.
- The concave supra-arch triple branched stent-graft system (CS system) is a novel device for aortic arch treatment.
- Objective evaluation of the CS system's efficacy and patient-specific design parameters is lacking.
Purpose of the Study:
- To assess the hemodynamic effectiveness of the CS system.
- To inform patient-specific CS system design by evaluating key hemodynamic parameters.
- To understand the impact of device geometry and patient anatomy on treatment outcomes.
Main Methods:
- Patient-specific computational fluid dynamics (CFD) simulations using pre- and post-operative CT angiography data from five cases.
- Parametric studies involving virtual adjustments of the CS system's concave degree (angle α) and patient-specific aortic diameters.
- Hemodynamic analysis including flow rate, pressure, time-averaged wall shear stress (TAWSS), and energy loss.
Main Results:
- CS system insertion maintained supra-aortic trunks (SATs) blood flow without significantly altering ascending aortic (AA) pressure or hemodynamics in normotensive and hypertensive states.
- Larger concave angles (α > 150°) improved SATs perfusion but increased hemodynamic variations; AA pressure increased by ~1.2%.
- Smaller aortic diameters led to substantially larger hemodynamic changes, with TAWSS increasing up to ~40% in smaller aortas (D1=30 mm).
Conclusions:
- The CS system demonstrates favorable hemodynamic features for treating aortic arch aneurysms, maintaining stability across different blood pressure conditions.
- Optimizing the concave angle is crucial; larger angles may enhance surgical convenience but pose risks of pressure elevation.
- Reducing the concave degree is recommended for patients with small aortic diameters to optimize the hemodynamic environment and inform patient-specific clinical decisions.
Background:
Concave supra-arch triple branched stent-graft system (CS system) offers a new option for treating aortic arch pathologies. However, the efficacy of the innovative device still lacks objective evaluations. Patient-specific CS system design and treatment strategies remain unknown. This study aims to assess the effectiveness and to inform the patient-specific CS system design by evaluating the hemodynamic effects of key parameters.
Methods:
Simulations were conducted via pre- and post-operative computed tomography angiography datasets from five first-in-man study cases. Parametric studies on the CS system were developed by virtually adjusting concave degree (angle α) in scenarios with patient-specific aortic diameter. Boundary conditions were obtained through three-element Windkessel model. Quantitative and qualitative hemodynamic analyses were conducted via flow rate, pressure, time-averaged wall shear stress (TAWSS)-based parameters and energy loss.
Results:
CS system insertion effectively maintained supra-aortic trunks (SATs) blood flow, without significantly affecting ascending aortic (AA) pressure and hemodynamic environments, regardless of postoperative normotensive (120/80 mmHg) or hypertensive (180/140 mmHg) states. Larger concave angles improved SATs perfusion by approximately 1-2%, with hemodynamic variations becoming notably more pronounced when α increased beyond 150°. Specifically, increases in SATs flow were 0.6-0.7% from 120° to 150°, compared with 1.8-2.0% from 150° to 180°, while flow to the left subclavian artery decreased by ~0.45% and ~0.75% over the same ranges. AA pressure changes remained small, with CS implantation increasing systolic pressure by only ~1.2%. Larger aortic diameters or smaller diameter differences between AA and descending aorta (DA) further reduced postoperative AA pressure by approximately 0.1-2%. Notably, patients with smaller aortic diameters exhibited substantially larger hemodynamic changes: for example, TAWSS in the thoracic aorta increased by up to ~40% when D1 =30 mm, compared with only ~10% when D1 =48 mm.
Conclusions:
CS system shows improved hemodynamic features in treating aortic arch aneurysm and can maintain stability under both normotensive and hypertensive postoperative blood pressure conditions. Larger concave angle can improve surgical convenience, but may also increase the risk of pressure elevation. For patients with small aortic diameters, reducing the concave degree may help to optimize the hemodynamic environment. The findings presented herein provide objective evaluation for assessing CS system outcomes and patient-specific clinical decision making.
