Compliant model of a coupled sequential coronary arterial bypass graft: effects of vessel wall elasticity and non-Newtonian rheology on blood flow regime and hemodynamic parameters distribution.

We have recently developed a novel design for coronary arterial bypass surgical grafting, consisting of coupled sequential side-to-side and end-to-side anastomoses. This design has been shown to have beneficial blood flow patterns and wall shear stress distributions which may improve the patency of the CABG, as compared to the conventional end-to-side anastomosis. In our preliminary computational simulation of blood flow of this coupled sequential anastomoses design, the graft and the artery were adopted to be rigid vessels and the blood was assumed to be a Newtonian fluid. Therefore, the present study has been carried out in order to (i) investigate the effects of wall compliance and non-Newtonian rheology on the local flow field and hemodynamic parameters distribution, and (ii) verify the advantages of the CABG coupled sequential anastomoses design over the conventional end-to-side configuration in a more realistic bio-mechanical condition. For this purpose, a two-way fluid-structure interaction analysis has been carried out. A finite volume method is applied to solve the three-dimensional, time-dependent, laminar flow of the incompressible, non-Newtonian fluid; the vessel wall is modeled as a linearly elastic, geometrically non-linear shell structure. In an iteratively coupled approach the transient shell equations and the governing fluid equations are solved numerically. The simulation results indicate a diameter variation ratio of up to 4% and 5% in the graft and the coronary artery, respectively. The velocity patterns and qualitative distribution of wall shear stress parameters in the distensible model do not change significantly compared to the rigid-wall model, despite quite large side-wall deformations in the anastomotic regions. However, less flow separation and reversed flow is observed in the distensible models. The wall compliance reduces the time-averaged wall shear stress up to 32% (on the heel of the conventional end-to-side model) and somewhat increases the oscillatory nature of the flow. It is found that the effects of wall compliance and non-Newtonian rheology are not independent, and they interact with each other. In spite of the modest influence of wall compliance and non-Newtonian rheology on the hemodynamic parameters distribution, the inclusion of these properties has unveiled further advantages of the coupled sequential anastomoses model over the conventional end-to-side anastomosis which had not been revealed in the previous study with the rigid-wall and Newtonian fluid models. Hence, the inclusion of wall compliance and non-Newtonian rheology in flow simulation of blood vessels can be essential in quantitative and comparative investigations.