title: Flow dynamics of the St Jude Medical Symmetry aortic connector vein graft anastomosis do not contribute to the risk of acute thrombosis.
abstract: BACKGROUND
  The efficacy of the St Jude Medical Symmetry aortic connector (St Jude Medical, Inc, St Paul, Minn) for coronary artery bypass is currently debated. Potential drawbacks are the biocompatibility of the endoluminal device, the need for graft manipulation during the procedure, and the 90 degrees offset of the vein graft from the ascending aorta, which may induce graft kinking and abnormal fluid dynamics. In this article, a computational approach was designed to investigate the fluid dynamics pattern at the proximal graft.
  
  
  METHODS
  Four models of hand-sewn anastomoses and two models of automated anastomoses were constructed; a finite volume technique was used to simulate realistic graft fluid dynamics, including aortic compliance and proper aortic and graft flow rates. The anastomosis geometry performance was analyzed by calculating time-averaged wall shear stress and the oscillating shear index at the toe and heel regions of the proximal graft.
  
  
  RESULTS
  Time-averaged wall shear stress was significantly lower in the hand-sewn anastomosis models than in the two models that simulated the use of the aortic connector (0.38 +/- 0.07 Pa vs 1.32 +/- 0.4 Pa). Higher oscillating shear index values were calculated in the hand-sewn anastomosis models (0.15 +/- 0.02 Pa vs 0.06 +/- 0.02 Pa).
  
  
  CONCLUSIONS
  Automated anastomosis geometry is associated with less critical fluid dynamics than with conventional hand-sewn anastomosis: the shape of the proximal graft induces more physiological wall shear stresses and less oscillating flow, suggesting a lower risk of atherosclerotic plaque and intimal hyperplasia as compared with conventional anastomosis geometry. Therefore, the reported early thrombosis and late failure of the St Jude Medical aortic connector anastomoses are not related to unfavorable fluid dynamics.
authors.affiliation: Department of Bioengineering, Politecnico di Milano, Milan, Italy. alberto.redaelli@polimi.it
authors.forename: A
authors.initials: A
authors.lastname: Redaelli
authors.forename: F
authors.initials: F
authors.lastname: Maisano
authors.forename: G
authors.initials: G
authors.lastname: Ligorio
authors.forename: E
authors.initials: E
authors.lastname: Cattaneo
authors.forename: F M
authors.initials: FM
authors.lastname: Montevecchi
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000208:Acute Disease; D000714:Anastomosis, Surgical; D001011:Aorta / Q000503:physiopathology* / Q000601:surgery*; D001021:Aortic Valve; D001783:Blood Flow Velocity / Q000502:physiology; D003198:Computer Simulation; D004867:Equipment Design; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008955:Models, Cardiovascular; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D013599:Systole / Q000502:physiology; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D014654:Vascular Patency / Q000502:physiology; D014680:Veins / Q000503:physiopathology* / Q000601:surgery*