A Hemodynamic-Based Evaluation of Applying Different Types of Coronary Artery Bypass Grafts to Coronary Artery Aneurysms (Retracted Article)
A Hemodynamic-Based Evaluation of Applying Different Types of Coronary Artery Bypass Grafts to Coronary Artery Aneurysms (Retracted Article)
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基于血流动力学的不同类型冠状动脉搭桥术治疗冠状动脉瘤的评估
DOI：
10.1155/2020/9359340
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发表时间：
2020-06-10
期刊：
影响因子：
2.3
通讯作者：
Ohta，Makoto
中科院分区：
文献类型：
--
作者：
Wang，Haoran;Anzai，Hitomi;Ohta，Makoto
冠状动脉旁路移植物（CABG），包括隐静脉移植物（SVG）或左乳内动脉（LIMA）移植物，最近被应用于治疗冠状动脉瘤（CAA）。手术结果被认为与手术策略（旁路移植物的类型和CAA是否结扎）和CAA的大小（通常以直径为特征）有关。然而，对手术结果与上述因素之间的关系的理解是有限的。与CABG治疗相关的既往研究表明，血流动力学研究可通过移植物质量流量、壁面剪切应力（WSS）和振荡剪切指数（OSI）帮助评价手术结局。我们认为，对冠状动脉旁路移植术应用于CAA的血流动力学研究，可以帮助我们了解不同的冠状动脉旁路移植术。本研究的目的是评价不同手术方法之间的血流动力学差异。为此，构建了8个三维模型，代表SVG和LIMA移植物应用于直径为正常直径2倍、3倍和5倍的CAA（无论是否结扎），以进行计算流体动力学（CFD）模拟。集总参数模型（LPM）与三维模型边界耦合，增加了仿真的复杂性，但可以保证仿真边界条件的稳定性。结果表明，SVG（无论是否结扎）血流动力学特征均为阳性，平均高移植物质量流速为70 ml/min，平均WSS为0.479 Pa，低OSI为0.001。CAA结扎组的LIMA具有相同的特征，WSS较高（平均1.701 Pa）。未结扎CAA的LIMA血流动力学特征为阴性，包括高反向质量流率和高OSI（0.367）。结果表明，LIMA加CAA结扎的手术效果可能是这些模型中最好的。由于高反向质量流和高OSI，不进行CAA结扎的LIMA的手术结果似乎不理想。CAA直径可能对手术结果没有显著影响。
Coronary artery bypass grafts (CABGs), including saphenous vein grafts (SVGs) or left internal mammary artery (LIMA) grafts, are recently applied to treat coronary artery aneurysm (CAA). Surgical outcomes are considered to be related to surgical strategies (types of the bypass graft and whether CAA ligated or not) and the size of the CAA (usually characterized by diameter). However, the understanding of the relationship between the surgical outcomes and the abovementioned factors is limited. Previous studies related to CABG treatments have shown hemodynamic studies could help evaluate surgical outcomes through graft mass flow rate, wall shear stress (WSS), and oscillatory shear index (OSI). It is believed that the hemodynamic study of applying CABGs to CAA, which is not studied yet, could help us understand the different CABG surgeries. The aim of the study was to evaluate the hemodynamic differences among different surgical methods. To do this, eight three-dimensional models were constructed, representing application of SVGs and LIMA grafts to CAAs (whether ligated or not) with diameters two, three, and five times the normal diameter, to perform computational fluid dynamics (CFD) simulation. The lumped-parameter model (LPM) was coupled to the boundary of the 3D models which increase the complexity of the simulation, but it can ensure the stability of the simulation boundary conditions. The results show that SVG (no matter whether ligated or not) hemodynamic characteristics are positive, with an average high graft mass flow rate of 70 ml/min, an average WSS of 0.479 Pa, and a low OSI of 0.001. LIMA with CAA ligation has the same characteristics with higher WSS (average 1.701 Pa). The hemodynamic characteristics of LIMA without CAA ligation are negative, including high reverse mass flow rate and high OSI (0.367). The results indicate that the surgical outcomes of LIMA with CAA ligation are likely to be the best among these models. The surgical outcomes of LIMA without CAA ligation seem to be undesirable due to the high reverse mass flow and high OSI. The CAA diameter may not have a significant effect on surgical outcomes.