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Abnormal Wall Shear Stress Area is Correlated to Coronary Artery Bypass Graft Remodeling 1 Year After Surgery

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Abstract

Coronary artery bypass graft surgery is a common intervention for coronary artery disease; however, it suffers from graft failure, and the underlying mechanisms are not fully understood. To better understand the relation between graft hemodynamics and surgical outcomes, we performed computational fluid dynamics simulations with deformable vessel walls in 10 study participants (24 bypass grafts) based on CT and 4D flow MRI one month after surgery to quantify lumen diameter, wall shear stress (WSS), and related hemodynamic measures. A second CT acquisition was performed one year after surgery to quantify lumen remodeling. Compared to venous grafts, left internal mammary artery grafts experienced lower abnormal WSS (< 1 Pa) area one month after surgery (13.8 vs. 70.1%, p = 0.001) and less inward lumen remodeling one year after surgery (− 2.4% vs. − 16.1%, p = 0.027). Abnormal WSS area one month post surgery correlated with percent change in graft lumen diameter one year post surgery (p = 0.030). This study shows for the first time prospectively a correlation between abnormal WSS area one month post surgery and graft lumen remodeling 1 year post surgery, suggesting that shear-related mechanisms may play a role in post-operative graft remodeling and might help explain differences in failure rates between arterial and venous grafts.

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Abbreviations

CABG:

Coronary artery bypass graft

CFD:

Computational fluid dynamics

CT:

Computed tomography

LIMA:

Left internal mammary artery

MRI:

Magnetic resonance imaging

RA:

Radial artery

SVG:

Saphenous vein graft

WSS:

Wall shear stress

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Acknowledgments

This work was supported by the RSNA Scholar Grant #RSCH1716, by the Department of Medical Imaging of the University of Toronto, by the Jean & Lauri Hiivala Research Fund for Heart Health, by the Institute of Biomedical Engineering of the University of Toronto, by the Canada Research Chairs program, and by Compute Canada.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Author notes

  1. Nhien Tran-Nguyen

    Present address: Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

Authors and Affiliations

  1. Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Piero Triverio

  2. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Andrew T. Yan & Laura Jimenez-Juan

  3. St. Michael’s Hospital, Toronto, ON, Canada

    Andrew T. Yan & Laura Jimenez-Juan

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Stephen Fremes

  5. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Stephen Fremes

  6. Sunnybrook Research Institute, Toronto, ON, Canada

    Stephen Fremes & Laura Jimenez-Juan

  7. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada

    Piero Triverio

  8. Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada

    Piero Triverio

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Correspondence to Nhien Tran-Nguyen.

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Tran-Nguyen, N., Yan, A.T., Fremes, S. et al. Abnormal Wall Shear Stress Area is Correlated to Coronary Artery Bypass Graft Remodeling 1 Year After Surgery. Ann Biomed Eng 51, 1588–1601 (2023). https://doi.org/10.1007/s10439-023-03167-4

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