Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation.
Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation.
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DOI：
10.1007/s10439-018-2043-5
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发表时间：
2018-09
影响因子：
3.8
通讯作者：
Pekkan K
中科院分区：
文献类型：
--
作者：
Lashkarinia SS;Piskin S;Bozkaya TA;Salihoglu E;Yerebakan C;Pekkan K
先天性心脏病（CHD）的外科治疗包括利用人工和天然手术材料进行复杂的血管重建。尽管术后复杂的血管生长模式和改变的压力负荷，成功的手术重建通过移植物获得最佳的血流动力学剖面。本文提出了一种新的针对患者的补片重建手术前计划框架，并研究了其计算可行性。该方案适用于法洛四联症冠心病模板肺动脉主动脉（MPA）狭窄的修补。研究了狭窄程度、手术切口的三维形状和人工补片的材料特性的影响。通过带壳单元的准静态有限元血管模型模拟手术切口残余应力的释放和切口间隙的额外开放以进行补片植入。模拟了不同形状的空载贴片的植入。将贴片动脉形态加压至术后生理血压水平25和45 mmHg，计算相应的术后应激分布和贴片动脉形态。通过对常用手术贴片材料（涤纶、聚四氟乙烯、人心包和猪异种心包）的力学性能进行双轴拉伸试验，获得内部应力应变数据，以表示贴片材料的力学行为。通过对3D打印的解剖狭窄复制品进行实际补片手术重建，实验验证了有限元模型。所有模型病例术后最初狭窄的管腔面积和术后弯曲的恢复都被量化。计算流体动力学求解器用于评估术后通过补片重建流出道的压降。根据我们的研究结果，与其他贴片设计方案相比，在喉咙处进行的较短切口导致相对较低的局部峰值应力值。较长的切口和双补片是修复初始狭窄水平最有效的方法。贴片插入后，由于血流引起的动脉压降从常规手术配置的9.8 mmHg降低到1.35 mmHg。这些结果与临床经验一致，即通过MPA的压力梯度达到或高于50mmhg可以作为干预的指征。所提出的术前规划框架的主要优势在于，它能够预测人工和天然贴片材料在术中和术后由于内径压力、切口长度和形态而引起的3D血管形状变化。本文的在线版本（10.1007/s10439-018-2043-5）包含补充内容，仅供授权用户使用。
Surgical treatment of congenital heart disease (CHD) involves complex vascular reconstructions utilizing artificial and native surgical materials. A successful surgical reconstruction achieves an optimal hemodynamic profile through the graft in spite of the complex post-operative vessel growth pattern and the altered pressure loading. This paper proposes a new in silico patient-specific pre-surgical planning framework for patch reconstruction and investigates its computational feasibility. The proposed protocol is applied to the patch repair of main pulmonary artery (MPA) stenosis in the Tetralogy of Fallot CHD template. The effects of stenosis grade, the three-dimensional (3D) shape of the surgical incision and material properties of the artificial patch are investigated. The release of residual stresses due to the surgical incision and the extra opening of the incision gap for patch implantation are simulated through a quasi-static finite-element vascular model with shell elements. Implantation of different unloaded patch shapes is simulated. The patched PA configuration is pressurized to the physiological post-operative blood pressure levels of 25 and 45 mmHg and the consequent post-operative stress distributions and patched artery shapes are computed. Stress–strain data obtained in-house, through the biaxial tensile tests for the mechanical properties of common surgical patch materials, Dacron, Polytetrafluoroethylene, human pericardium and porcine xenopericardium, are employed to represent the mechanical behavior of the patch material. Finite-element model is experimentally validated through the actual patch surgery reconstructions performed on the 3D printed anatomical stenosis replicas. The post-operative recovery of the initially narrowed lumen area and post-op tortuosity are quantified for all modeled cases. A computational fluid dynamics solver is used to evaluate post-operative pressure drop through the patch-reconstructed outflow tract. According to our findings, the shorter incisions made at the throat result in relatively low local peak stress values compared to other patch design alternatives. Longer cut and double patch cases are the most effective in repairing the initial stenosis level. After the patch insertion, the pressure drop in the artery due to blood flow decreases from 9.8 to 1.35 mmHg in the conventional surgical configuration. These results are in line with the clinical experience where a pressure gradient at or above 50 mmHg through the MPA can be an indication to intervene. The main strength of the proposed pre-surgical planning framework is its capability to predict the intra-operative and post-operative 3D vascular shape changes due to intramural pressure, cut length and configuration, for both artificial and native patch materials. The online version of this article (10.1007/s10439-018-2043-5) contains supplementary material, which is available to authorized users.
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影响因子：
2.4
作者：
Dur, Onur;Yoshida, Masahiro;Pekkan, Kerem
通讯作者：
Pekkan, Kerem
影响因子：
4.3
作者：
Pasta, Salvatore;Cho, Jae-Sung;Vorp, David A.
通讯作者：
Vorp, David A.
影响因子：
3.8
作者：
Bloodworth, Charles H.;Pierce, Eric L.;Yoganathan, Ajit P.
通讯作者：
Yoganathan, Ajit P.
Fontan 转换模板：侧通道与开窗心房导管的患者特定血流动力学性能
影响因子：
1.6
作者：
Hong, Haifa;Dur, Onur;Liu, Jinfen
通讯作者：
Liu, Jinfen
DOI：
10.1136/heartjnl-2016-310423
发表时间：
2017-01-15
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Biglino G;Capelli C;Bruse J;Bosi GM;Taylor AM;Schievano S
通讯作者：
Schievano S