A novel coronary artery bypass graft design of sequential anastomoses.

In this paper, the hemodynamics in a three-dimensional out-of-plane sequential bypass graft model is first investigated. Based on the advantageous flow characteristics observed within the side-to-side (STS) anastomosis in the sequential bypass graft simulation, a new CABG coupled-sequential anastomosis configuration is designed, entailing coupled STS and end-to-side (ETS) anastomotic components. In this new CABG design, the flow fields and distributions of various wall shear stress parameters within the STS and ETS anastomotic regions are studied, and compared to those of the conventional distal anastomosis, by means of computational fluid dynamics simulation of pulsatile Newtonian blood flow. Simulation results demonstrate that the new sequential anastomoses model provides: (i) a more uniform and smooth flow at the ETS anastomosis, without any stagnation point on the artery bed and vortex formation in the heel region of the ETS anastomosis within the coronary artery; (ii) a spare route for the blood flow to the coronary artery, to avoid re-operation in case of re-stenosis in either of the anastomoses; and (iii) improved distribution of hemodynamic parameters at the coronary artery bed and in the heel region of the ETS anastomosis, with more moderate shear stress indices. These advantages of the new design over the conventional ETS anastomosis are influenced by the occlusion ratio of the native coronary artery, and are most prominent when the proximal segment of the coronary artery is fully occluded. By varying the design parameters of the anastomotic angle and distance between the two anastomoses, the superior coupled STS-ETS anastomoses design is found to have the anastomotic angle of 30° and 30 mm distance between the two (STS and ETS) components.