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Multilayer flow modulator enhances vital organ perfusion in patients with type B aortic dissection.
- Source :
-
American journal of physiology. Heart and circulatory physiology [Am J Physiol Heart Circ Physiol] 2018 Nov 01; Vol. 315 (5), pp. H1182-H1193. Date of Electronic Publication: 2018 Aug 10. - Publication Year :
- 2018
-
Abstract
- Management of aortic dissections (AD) is still challenging, with no universally approved guideline among possible surgical, endovascular, or medical therapies. Approximately 25% of patients with AD suffer postintervention malperfusion syndrome or hemodynamic instability, with the risk of sudden death if left untreated. Part of the issue is that vascular implants may themselves induce flow disturbances that critically impact vital organs. A multilayer mesh construct might obviate the induced flow disturbances, and it is this concept we investigated. We used preintervention and post-multilayer flow modulator implantation (PM) geometries from clinical cases of type B AD. In-house semiautomatic segmentation routines were applied to computed tomography images to reconstruct the lumen. The device was numerically reconstructed and adapted to the PM geometry concentrically fit to the true lumen centerline. We also numerically designed a pseudohealthy case, where the geometry of the aorta was extracted interpolating geometric features of preintervention, postimplantation, and published representative healthy volunteers. Computational fluid dynamics methods were used to study the time-dependent flow patterns, shear stress metrics, and perfusion to vital organs. A three-element Windkessel lumped parameter module was coupled to a finite-volume solver to assign dynamic outlet boundary conditions. Multilayer flow modulator not only significantly reduced false lumen blood flow, eliminated local flow disturbances, and globally regulated wall shear stress distribution but also maintained physiological perfusion to peripheral vital organs. We propose further investigation to focus the management of AD on both modulation of blood flow and restoration of physiologic end-organ perfusion rather than mere restoration of vascular lamina morphology. NEW & NOTEWORTHY The majority of aortic dissection modeling efforts have focused on the maintenance of physiological flow using minimally invasive placed grafts. The multilayer flow modulator is a complex mesh construct of wires, designed to eliminate flow disruptions in the lumen, regulate the physiological wall stresses, and enhance endothelial function and offering the promise of improved perfusion of vital organs. This has never been fully proved or modeled, and these issues we confirmed using a dynamic framework of time-varying arterial waveforms.
- Subjects :
- Aortic Dissection diagnostic imaging
Aortic Dissection physiopathology
Aortic Aneurysm diagnostic imaging
Aortic Aneurysm physiopathology
Aortography methods
Blood Flow Velocity
Computed Tomography Angiography
Humans
Hydrodynamics
Models, Cardiovascular
Patient-Specific Modeling
Prosthesis Design
Radiographic Image Interpretation, Computer-Assisted
Regional Blood Flow
Time Factors
Treatment Outcome
Aortic Dissection surgery
Aortic Aneurysm surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation instrumentation
Hemodynamics
Subjects
Details
- Language :
- English
- ISSN :
- 1522-1539
- Volume :
- 315
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American journal of physiology. Heart and circulatory physiology
- Publication Type :
- Academic Journal
- Accession number :
- 30095992
- Full Text :
- https://doi.org/10.1152/ajpheart.00199.2018