Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models.
Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models.
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DOI：
10.1016/j.xjon.2022.08.006
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发表时间：
2022-12
期刊：
影响因子：
--
通讯作者：
Hibino, Narutoshi
中科院分区：
文献类型：
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作者：
Contento, Jacqueline;Mass, Paige;Cleveland, Vincent;Aslan, Seda;Matsushita, Hiroshi;Hayashi, Hidenori;Nguyen, Vivian;Kawaji, Keigo;Loke, Yue-Hin;Nelson, Kevin;Johnson, Jed;Krieger, Axel;Olivieri, Laura;Hibino, Narutoshi
虽然使用计算流体力学的手术模拟已经取得了进步，但在针对患者的设计之后，对心脏外科手术的准确性知之甚少。我们在猪模型中评估了特定于患者的模拟和实际植入的位置不同对特定于患者的组织工程血管移植物(TEVGs)血流动力学性能的影响。在猪模型(n=11)中采集磁共振血管成像和4维(4D)血流数据，以创建个性化的TEVG。通过在金属芯棒上静电纺丝生物可吸收材料来优化和制造移植物形状。于成像后1个月或3个月植入TEVG，获取术后磁共振血管成像和4D血流数据并进行分割。通过质心分析确定TEVG预期位置和观测位置之间的位移。血流动力学数据由4D血流分析获得。移位和血流动力学数据采用线性回归进行比较。与手术模拟的预期位置相比，患者特定的TEVG在植入过程中移位了1至8 mm。预期位置和观察位置之间的偏移量越大，术后血管系统的壁切应力(WSS)越大(P<0.01)。植入距离预定位置较近的移植物显示WSS降低。患者特定的TEVG设计用于精确的位置，以帮助优化血流动力学性能。然而，如果TEVGs被植入的位置远离其预期位置，则观察到更糟糕的WSS。这不仅强调了针对患者的设计的重要性，而且强调了精确引导植入在心脏手术中优化血流动力学和增加手术模拟的重复性的重要性。
Although surgical simulation using computational fluid dynamics has advanced, little is known about the accuracy of cardiac surgical procedures after patient-specific design. We evaluated the effects of discrepancies in location for patient-specific simulation and actual implantation on hemodynamic performance of patient-specific tissue-engineered vascular grafts (TEVGs) in porcine models. Magnetic resonance angiography and 4-dimensional (4D) flow data were acquired in porcine models (n = 11) to create individualized TEVGs. Graft shapes were optimized and manufactured by electrospinning bioresorbable material onto a metal mandrel. TEVGs were implanted 1 or 3 months postimaging, and postoperative magnetic resonance angiography and 4D flow data were obtained and segmented. Displacement between intended and observed TEVG position was determined through center of mass analysis. Hemodynamic data were obtained from 4D flow analysis. Displacement and hemodynamic data were compared using linear regression. Patient-specific TEVGs were displaced between 1 and 8 mm during implantation compared with their surgically simulated, intended locations. Greater offset between intended and observed position correlated with greater wall shear stress (WSS) in postoperative vasculature (P < .01). Grafts that were implanted closer to their intended locations showed decreased WSS. Patient-specific TEVGs are designed for precise locations to help optimize hemodynamic performance. However, if TEVGs were implanted far from their intended location, worse WSS was observed. This underscores the importance of not only patient-specific design but also precision-guided implantation to optimize hemodynamics in cardiac surgery and increase reproducibility of surgical simulation.