Hemodynamic analysis of sequential graft from right coronary system to left coronary system.
BACKGROUND
Sequential and single grafting are two surgical procedures of coronary artery bypass grafting. However, it remains unclear if the sequential graft can be used between the right and left coronary artery system. The purpose of this paper is to clarify the possibility of right coronary artery system anastomosis to left coronary system.


METHODS
A patient-specific 3D model was first reconstructed based on coronary computed tomography angiography (CCTA) images. Two different grafts, the normal multi-graft (Model 1) and the novel multi-graft (Model 2), were then implemented on this patient-specific model using virtual surgery techniques. In Model 1, the single graft was anastomosed to right coronary artery (RCA) and the sequential graft was adopted to anastomose left anterior descending (LAD) and left circumflex artery (LCX). While in Model 2, the single graft was anastomosed to LAD and the sequential graft was adopted to anastomose RCA and LCX. A zero-dimensional/three-dimensional (0D/3D) coupling method was used to realize the multi-scale simulation of both the pre-operative and two post-operative models.


RESULTS
Flow rates in the coronary artery and grafts were obtained. The hemodynamic parameters were also showed, including wall shear stress (WSS) and oscillatory shear index (OSI). The area of low WSS and OSI in Model 1 was much less than that in Model 2.


CONCLUSIONS
Model 1 shows optimistic hemodynamic modifications which may enhance the long-term patency of grafts. The anterior segments of sequential graft have better long-term patency than the posterior segments. With rational spatial position of the heart vessels, the last anastomosis of sequential graft should be connected to the main branch.
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China.
Wenxin
W
Wang
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China.
Boyan
B
Mao
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China.
Haoran
H
Wang
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China.
Xueying
X
Geng
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China.
Xi
X
Zhao
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China.
Huixia
H
Zhang
Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Jinsheng
J
Xie
Peking University People's Hospital, Beijing, China.
Zhou
Z
Zhao
Peking University People's Hospital, Beijing, China.
Bo
B
Lian
College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, 100124, Beijing, China. lyjlma@bjut.edu.cn.
Youjun
Y
Liu
D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology*; D001158:Arteries / Q000503:physiopathology; D003198:Computer Simulation; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D008955:Models, Cardiovascular; D011312:Pressure; D012306:Risk; D033081:Shear Strength; D015607:Stents; D013314:Stress, Mechanical; D013927:Thrombosis / Q000503:physiopathology
Computational fluid dynamic (CFD); Hemodynamics; Multi-branch; Sequential graft