Computer-Aided Patient-Specific Coronary Artery Graft Design Improvements Using CFD Coupled Shape Optimizer.
Computer-Aided Patient-Specific Coronary Artery Graft Design Improvements Using CFD Coupled Shape Optimizer.
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DOI：
10.1007/s13239-010-0029-z
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发表时间：
2011-03
影响因子：
1.8
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中科院分区：
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本研究旨在（i）证明复杂心血管重建的新手术计划框架的有效性，（ii）开发计算流体动力学（CFD）耦合多维形状优化方法，以帮助患者特定的冠状动脉旁路移植术（CABG）设计，以及（iii）比较连续CABG的血流动力学效率，即，在患者特定的3D设置中从母体CABG升高子平行分支。研究了右冠状动脉（RCA）、左前降支（LAD）和左回旋支（LCX）旁路术的患者特定完全血运重建方案的血流动力学效率，并与狭窄条件进行了比较。多变量2D约束优化应用于左乳内动脉（LIMA）移植物，其基于从2D CT切片提取的实际手术设置进行参数化。目标函数设定为最小化壁面剪切应力（WSS）和其他血流动力学指标（能量耗散、流动偏离角、平均WSS和涡度）的局部变化，这些指标与移植物性能和吻合区再狭窄风险相关。一旦获得了优化的2D移植物形状，就使用内部“基于草图”的交互式解剖编辑工具将其转换为3D。使用实验验证的二阶非牛顿CFD求解器结合基于阻力的出口边界条件对最终移植物设计进行评估。健康冠状动脉解剖结构的3D患者特定模拟产生了逼真的冠状动脉血流。所有血运重建技术均将冠状动脉灌注恢复至健康基线。优化的LIMA移植物的多尺度评价能够显著缓解壁面剪切应力梯度（WSSG）（~34%）。与原始LIMA移植物相比，连续移植物还使LAD和对角分叉近端的WSSG降低了15%。所提出的基于草图的手术计划范例评价了基于急性血流动力学再调整的冠状动脉旁路手术。这种方法可以提供一个合理的，以帮助在时间紧迫的，患者特定的CA旁路手术在体内执行之前的手术决策。
This study aims to (i) demonstrate the efficacy of a new surgical planning framework for complex cardiovascular reconstructions, (ii) develop a computational fluid dynamics (CFD) coupled multi-dimensional shape optimization method to aid patient-specific coronary artery by-pass graft (CABG) design and, (iii) compare the hemodynamic efficiency of the sequential CABG, i.e., raising a daughter parallel branch from the parent CABG in patient-specific 3D settings. Hemodynamic efficiency of patient-specific complete revascularization scenarios for right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) bypasses were investigated in comparison to the stenosis condition. Multivariate 2D constraint optimization was applied on the left internal mammary artery (LIMA) graft, which was parameterized based on actual surgical settings extracted from 2D CT slices. The objective function was set to minimize the local variation of wall shear stress (WSS) and other hemodynamic indices (energy dissipation, flow deviation angle, average WSS, and vorticity) that correlate with performance of the graft and risk of re-stenosis at the anastomosis zone. Once the optimized 2D graft shape was obtained, it was translated to 3D using an in-house “sketch-based” interactive anatomical editing tool. The final graft design was evaluated using an experimentally validated second-order non-Newtonian CFD solver incorporating resistance based outlet boundary conditions. 3D patient-specific simulations for the healthy coronary anatomy produced realistic coronary flows. All revascularization techniques restored coronary perfusions to the healthy baseline. Multi-scale evaluation of the optimized LIMA graft enabled significant wall shear stress gradient (WSSG) relief (~34%). In comparison to original LIMA graft, sequential graft also lowered the WSSG by 15% proximal to LAD and diagonal bifurcation. The proposed sketch-based surgical planning paradigm evaluated the selected coronary bypass surgery procedures based on acute hemodynamic readjustments of aorta-CA flow. This methodology may provide a rational to aid surgical decision making in time-critical, patient-specific CA bypass operations before in vivo execution.