Theodorus M van Bakel1,2,3, Christopher J Arthurs4, Joost A van Herwaarden3, Frans L Moll3, Kim A Eagle5, Himanshu J Patel6, Santi Trimarchi2, C Alberto Figueroa1,7. 1. Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 2. Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Milan, Italy. 3. Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands. 4. Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. 5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 6. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA. 7. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
Abstract
OBJECTIVES: Aortic arch repair remains a major surgical challenge. Multiple manufacturers are developing branched endografts for Zone 0 endovascular repair, extending the armamentarium for minimally invasive treatment of aortic arch pathologies. We hypothesize that the design of the Zone 0 endograft has a significant impact on the postoperative haemodynamic performance, particularly in the cervical arteries. The goal of our study was to compare the postoperative haemodynamic performance of different Zone 0 endograft designs. METHODS: Patient-specific, clinically validated, computational fluid dynamics simulations were performed in a 71-year-old woman with a 6.5-cm saccular aortic arch aneurysm. Additionally, 4 endovascular repair scenarios using different endograft designs were created. Haemodynamic performance was evaluated by calculation of postoperative changes in blood flow and platelet activation potential (PLAP) in the cervical arteries. RESULTS: Preoperative cervical blood flow and mean PLAP were 1080 ml/min and 151.75, respectively. Cervical blood flow decreased and PLAP increased following endovascular repair in all scenarios. Endografts with 2 antegrade inner branches performed better compared to single-branch endografts. Scenario 3 performed the worst with a decrease in the total cervical blood flow of 4.8%, a decrease in the left hemisphere flow of 6.7% and an increase in the mean PLAP of 74.3%. CONCLUSIONS: Endograft design has a significant impact on haemodynamic performance following Zone 0 endovascular repair, potentially affecting cerebral blood flow during follow-up. Our results demonstrate the use of computational modelling for virtual testing of therapeutic interventions and underline the need to monitor the long-term outcomes in this cohort of patients.
OBJECTIVES: Aortic arch repair remains a major surgical challenge. Multiple manufacturers are developing branched endografts for Zone 0 endovascular repair, extending the armamentarium for minimally invasive treatment of aortic arch pathologies. We hypothesize that the design of the Zone 0 endograft has a significant impact on the postoperative haemodynamic performance, particularly in the cervical arteries. The goal of our study was to compare the postoperative haemodynamic performance of different Zone 0 endograft designs. METHODS:Patient-specific, clinically validated, computational fluid dynamics simulations were performed in a 71-year-old woman with a 6.5-cm saccular aortic arch aneurysm. Additionally, 4 endovascular repair scenarios using different endograft designs were created. Haemodynamic performance was evaluated by calculation of postoperative changes in blood flow and platelet activation potential (PLAP) in the cervical arteries. RESULTS: Preoperative cervical blood flow and mean PLAP were 1080 ml/min and 151.75, respectively. Cervical blood flow decreased and PLAP increased following endovascular repair in all scenarios. Endografts with 2 antegrade inner branches performed better compared to single-branch endografts. Scenario 3 performed the worst with a decrease in the total cervical blood flow of 4.8%, a decrease in the left hemisphere flow of 6.7% and an increase in the mean PLAP of 74.3%. CONCLUSIONS: Endograft design has a significant impact on haemodynamic performance following Zone 0 endovascular repair, potentially affecting cerebral blood flow during follow-up. Our results demonstrate the use of computational modelling for virtual testing of therapeutic interventions and underline the need to monitor the long-term outcomes in this cohort of patients.
Authors: Theodorus M J van Bakel; Christopher J Arthurs; Foeke J H Nauta; Kim A Eagle; Joost A van Herwaarden; Frans L Moll; Santi Trimarchi; Himanshu J Patel; C Alberto Figueroa Journal: Eur J Cardiothorac Surg Date: 2019-06-01 Impact factor: 4.191
Authors: Theodorus M J van Bakel; Nicholas S Burris; Himanshu J Patel; C Alberto Figueroa Journal: Eur J Cardiothorac Surg Date: 2019-09-01 Impact factor: 4.191
Authors: Theodorus M van Bakel; Hector W de Beaufort; Santi Trimarchi; Massimiliano M Marrocco-Trischitta; Jean Bismuth; Frans L Moll; Himanshu J Patel; Joost A van Herwaarden Journal: Ann Cardiothorac Surg Date: 2018-05
Authors: Michele Conti; Rodrigo M Romarowski; Anna Ferrarini; Matteo Stochino; Ferdinando Auricchio; Simone Morganti; Ludwig Karl von Segesser; Enrico Ferrari Journal: Interact Cardiovasc Thorac Surg Date: 2021-04-08
Authors: Yunus Ahmed; Christopher Tossas-Betancourt; Pieter A J van Bakel; Jonathan M Primeaux; William J Weadock; Jimmy C Lu; Jeffrey D Zampi; Arash Salavitabar; C Alberto Figueroa Journal: Front Physiol Date: 2021-08-13 Impact factor: 4.566