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Computational fluid dynamics simulations of flow distribution and graft designs in apicoaortic bypass

Abstract

Objective

Apicoaortic bypass has double outlets and its graft design is similar to that of a left ventricular assist device (LVAD). The left ventricular apex to the descending aorta (LV-DsAo) bypass is widely used in apicoaortic bypass. In contrast, the left ventricular apex to the ascending aorta (LV-AsAo) bypass is standard in LVAD surgery. This study aimed to evaluate the graft designs of apicoaortic bypass and their effects on flow distribution and energy loss (EL).

Methods

A simulation study using computational fluid dynamics was performed on the geometry and hemodynamics data obtained from a 30-year-old patient who underwent a LV-DsAo bypass. The ratio of the cardiac output (CO) through the ascending aorta (AsAo) and apicoaortic conduit was set at 50:50, 30:70, and 10:90. Regional blood flow (RBF) and EL were calculated for the different distribution ratios. As an alternative to the LV-DsAo bypass, a virtual LV-AsAo bypass surgery was performed, and each parameter was compared with that of the LV-DsAo bypass.

Results

At a distribution ratio of 50:50, the RBF to the head and EL were 16.4% of the total CO and 62.0 mW in the LV-DsAo bypass, and 32.3% and 81.5 mW in the LV-AsAo bypass, respectively. The RBF to the head decreased with the CO through the AsAo in the LV-DsAo bypass, but it was constant in the LV-AsAo bypass. The EL increased inversely with the CO through the AsAo in both graft designs.

Conclusion

The regional blood flow distribution was different, but the trend of the EL which increased inversely with the CO through the AsAo was similar between the LV-DsAo and LV-AsAo bypasses.

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References

  1. Kawahito K, Kimura N, Komiya K, Nakamura M, Misawa Y. Blood flow competition after aortic valve bypass: an evaluation using computational fluid dynamics. Interact Cardiovasc Thorac Surg. 2017;24:670–6.

    PubMed  Google Scholar 

  2. Balaras E, Cha KS, Griffith BP, Gammie JS. Treatment of aortic stenosis with aortic valve bypass (apicoaortic conduit) surgery: as assessment using computational modeling. J Thorac Cardiovasc Surg. 2009;137:680–7.

    Article  Google Scholar 

  3. Stauffer CE, Jeudy J, Ghoreishi M, Vliek C, Young C, Griffith B, et al. Magnetic resonance investigation of blood flow after aortic valve bypass (apicoaortic conduit). Ann Thorac Surg. 2011;92:1332–8.

    Article  Google Scholar 

  4. Benevento E, Djebbari A, Keshavarz-Motamed Z, Cecere R, Kadem L. Hemodynamic changes following aortic valve bypass: a mathematical approach. PLoS ONE. 2015;10:e0123000.

    Article  Google Scholar 

  5. Kotani S, Hattori K, Kato Y, Shibata T. Thrombus in the distal aortic arch after apicoaortic conduit for severe aortic stenosis. Interact Cardiovasc Thorac Surg. 2010;10:486–8.

    Article  Google Scholar 

  6. Norman JC, Nihill MR, Cooley DA. Valved apico-aortic composite conduits for left ventricular outflow tract obstructions. Am J Cardiol. 1980;45:1265–71.

    CAS  Article  Google Scholar 

  7. Rocchini AP, Brown J, Crowley DC, Girod DA, Behrendt D, Rosenthal A. Clinical and hemodynamic follow-up of left ventricular to aortic conduits in patients with aortic stenosis. J Am Coll Cardiol. 1983;1:1135–43.

    CAS  Article  Google Scholar 

  8. Shimizu S, Nakai M, Itoh A, Yoshizumi K, Ochi Y, Okada M, et al. Apico-brachiocephalic artery bypass for aortic stenosis with porcelain aorta. Ann Thorac Surg. 2010;89:621–3.

    Article  Google Scholar 

  9. Elmistekawy E, Lapierre H, Mesana T, Ruel M. Apico-aortic conduit for severe aortic stenosis: technique, applications, and systemic review. J Saudi Heart Assoc. 2010;22:187–94.

    Article  Google Scholar 

  10. Miyaji K, Miyazaki S, Itatani K, Oka N, Kitamura T, Horai T. Novel surgical strategy for complicated pulmonary stenosis using haemodynamic analysis based on a virtual operation with numerical flow analysis. Interact Cardiovasc Thorac Surg. 2018. https://doi.org/10.1093/icvts/ivy326.

    Article  PubMed  Google Scholar 

  11. Miyazaki S, Itatani K, Furusawa T, Nishino T, Sugiyama M, Takehara Y, et al. Validation of numerical simulation methods in aortic arch using 4D flow MRI. Heart Vessels. 2017;32:1032–44.

    Article  Google Scholar 

  12. Qian Y, Liu JL, Itatani K, Miyaji K, Umezu M. Computational hemodynamic analysis in congenital heart disease: Simulation of the Norwood procedure. Ann Biomed Eng. 2010;37:2302–13.

    Article  Google Scholar 

  13. Goto S, Nakamura M, Itatani K, Miyazaki S, Oka N, Honda T, et al. Synchronization of the flow and pressure wave obtained with non-simultaneous multipoint measurements. Effects of the cut-off frequencies for breathing and heartbeat on blood flow analysis in the Fontan circulation. Int Heart J. 2016;57:449–55.

    Article  Google Scholar 

  14. Itatani K, Miyazaki S, Furusawa T, Numata S, Yamazaki S, Morimoto K, Makino R, Morichi H, Nishiono T, Yaku H. New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI. Gen Thorac Cardiovasc Surg. 2017;65(11):611–21.

    Article  Google Scholar 

  15. Numata S, Itatani K, Yamazaki S, Doi K, Kanda K, Yaku H. Blood flow analysis of arch using computational fluid dynamics. Euro J Cardiothorac Surg. 2016;49(6):1578–85.

    Article  Google Scholar 

  16. Honda T, Itatani K, Takanashi M, Kitagawa A, Ando H, Kimura S, et al. Contributions of respiration and heartbeat to the pulmonary blood flow in the Fontan circulation. Ann Thorac Surg. 2016;102:1596–606.

    Article  Google Scholar 

  17. Itatani K, Miyaji K, Qian Y, Liu JL, Miyakoshi T, Murakami A, et al. Influences of surgical arch reconstruction methods on single ventricle workload in the Norwood procedure. J Thorac Cardiovasc Surg. 2012;144:130–8.

    Article  Google Scholar 

  18. Shibata M, Itatani K, Hayashi T, Honda T, Kitagawa A, Miyaji K, et al. Flow energy loss as a predictive parameter for right ventricular deterioration caused by pulmonary regurgitation after tetralogy of Fallot repair. Pediatr Cardiol. 2018;39:731–42.

    Article  Google Scholar 

  19. Fragomeni G, Rossi M, Condemi F, Mazzitelli R, Serraino GF, Renzulli A. Apicoaortic conduit and cerebral perfusion in mixed aortic valve disease: a computational analysis. Interact Cardiovasc Thorac Surg. 2013;17:950–5.

    Article  Google Scholar 

  20. Ganong WF. Review of Medical Physiology 22nd: 612, table 32-1. Resting blood flow and O2 consumption of various organs in a 63-kg adult man with a mean arterial blood pressure of 90 mmHg and O2 consumption of 250 ml/min

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Correspondence to Takashi Sasaki.

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Conflict of interest

Keiichi Itatani is an equity shareholder and founder of Cardio Flow Design Inc. (Tokyo, Japan), the vender of the blood flow analysis tool.

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Sasaki, T., Ueda, H., Itatani, K. et al. Computational fluid dynamics simulations of flow distribution and graft designs in apicoaortic bypass. Gen Thorac Cardiovasc Surg 69, 811–818 (2021). https://doi.org/10.1007/s11748-020-01527-8

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  • DOI: https://doi.org/10.1007/s11748-020-01527-8

Keywords

  • Apicoaortic bypass
  • Flow distribution
  • Graft design
  • Computational fluid dynamics
  • Energy loss
  • Cerebral perfusion