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A Computational Analysis Of Branched Endograft Designs For Zone 0 Endovascular Aortic Arch Repair
William J. Yoon, MD, PhD.
1, Andres Schanzer, MD
2, Jae Cho, MD
1, Kevin Mani, MD, PhD.
3, Anders Wanhainen, MD, PhD.
3.
1Case Western Reserve University-UH Harrington Heart & Vascular Institute, Cleveland, OH, USA,
2University of Massachusetts Medical School, Worcester, MA, USA,
3Uppsala University, Uppsala, Sweden.
OBJECTIVES: To evaluate the hemodynamic response induced by implantation of Zone 0 branched endografts.
METHODS: This retrospective multicenter study included 28 patients who underwent zone 0 endovascular repair using 1-, 2-, 3-branched endografts (n=7, n=11, n=10, respectively), using the Nexus system (Endospan Ltd.) and the Zenith Arch Branch Device (Cook Medical). All 2-branch endografts were designed with two antegrade branches. Of ten 3-branch endografts, eight endografts were designed with two antegrade and one retrograde branches, and the other two with three retrograde branches. Any extra-anatomical bypasses (IA-LCCA-LSA bypass and LCCA-LSA bypass) were included in the analysis. Pre- and post-implantation aortic models were reconstructed from patients’ computed tomography (CT) scans and 56 computational fluid dynamics (CFD) simulations were performed. Hemodynamic consequences were evaluated by calculating post-implantation changes in blood flow (flow rate, pressure, time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI)) at the innominate artery (IA), right subclavian artery (RSA), right common carotid artery (RCCA), left common carotid artery (LCCA), and left subclavian artery (LSA).
RESULTS: 1-branch devices (IA only inflow vessel combined with extraanatomic bypasses) demonstrated an increase in peak flow in the IA and RSA and a decrease in both LCCA and LSA (Figure 1A). 2-branch devices demonstrated no significant post-implantation hemodynamic changes in the IA except for increased TAWSS (p=0.019) and no significant post-implantation hemodynamic changes for RSA and RCCA. There was no change in peak flow in LCCA (p=1.0) but a decrease in peak flow in LSA (p=0.01) and reduced systolic pressure in both LCCA (p=0.005) and LSA (p<.001) (Figure 1B). 3-branch devices demonstrated no significant post-implantation hemodynamic changes in the IA except for increased TAWSS (p=0.004). There were no significant post-implantation hemodynamic changes for RSA, RCCA, or LCCA, while a reduced peak flow (p=0.006) and a trend of reduced systolic pressure was seen in the LSA (p=0.08) (Figure 1C).
CONCLUSIONS: Changing the number of branches influences local hemodynamic patterns inside the arch vessels. Hemodynamic changes decrease as the number of branches increases. Further investigation of the clinical effects of these hemodynamic changes is needed.
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