Computational fluid dynamic study of multiple sequential coronary artery bypass anastomoses in a native coronary stenosis model.
Computational fluid dynamic study of multiple sequential coronary artery bypass anastomoses in a native coronary stenosis model.
复制标题
自然冠状动脉狭窄模型中多个连续冠状动脉旁路吻合的计算流体动力学研究。
DOI：
10.1097/mca.0000000000000864
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Matsumiya G.
中科院分区：
文献类型：
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作者：
Matsuura K;Jin WW;Liu H;Matsumiya G.
本研究的目的是用计算流体力学的方法评价多支序贯冠状动脉搭桥术的血流动力学特性。方法一次吻合分为平行吻合和菱形吻合，二次吻合为端侧吻合。吻合口长度固定在2 mm。对第一和第二狭窄程度的不同组合进行了研究。自体血管和移植血管的直径均为2 mm。结果狭窄口和吻合口均出现漩涡和停滞现象。当第二次狭窄的严重程度大于第一次狭窄时，第二次狭窄的出口血流更不稳定。一期吻合术绕过重度狭窄时，尤其是钻石吻合术时，管壁切应力较高，剪切指数振荡范围较大。狭窄程度较重的血管作为二次吻合口时，能量损失较少，能量利用率较高。在两种狭窄程度相同的情况下，平行吻合的能量损失低于钻石吻合，能量效率高于钻石吻合。结论在采用多个序贯搭桥术时，首先采用平行吻合的方法绕过狭窄程度较轻的血管较为理想。根据计算流体动力学模型，这提高了血流动力学稳定性和能量效率。
BackgroundThe objective of this study was to evaluate the hemodynamic characteristics of multiple sequential coronary artery bypass grafting using a computational fluid dynamics study.MethodsFirst anastomosis was configured into parallel and diamond anastomoses, and the second anastomosis was set as end-side anastomosis. The anastomosis incision lengths were fixed at 2 mm. Various combinations of the degree of first and second stenoses were studied. The diameter of both the native and graft vessels was set at 2 mm. The inlet boundary condition was set by a sample of the transient time flow measurement, which was measured intraoperatively.ResultsBoth swirl and stagnation were observed at the outlets of the stenosis and the anastomosis sites. When the severity of the second stenosis was larger than that of the first, the flow at the outlet of the second stenosis was more unstable. Higher wall shear stress and larger oscillatory shear index regions were observed when the severe stenosis was bypassed by the first anastomosis, especially with diamond anastomoses. Less energy loss and higher energy efficiency were present when the vessel with more severe stenosis was bypassed as the second anastomosis. Energy loss was lower and energy efficiency was higher with parallel anastomosis than diamond anastomosis when the severity of the two stenoses was the same.ConclusionsIt is ideal to bypass the less severe stenosis vessel first with a parallel anastomosis method when employing multiple sequential bypass grafting. This improves hemodynamic stability and energy efficiency, according to a computational fluid dynamics model.