Coronary artery bypass grafting planning based on hemodynamic simulation

Abstract

Abstract Purpose A common surgical methods for the treatment of coronary heart disease is coronary artery bypass grafting ( CABG ). The most important concern is the graft patency. When restenosis or occlusion occurs on the graft, the blood supply to the downstream will be reduced, and serious myocardial ischemia will occur again. Hemodynamics are the key factors affecting the graft patency. If the hemodynamic results of the graft under different surgical methods can be known before coronary artery bypass grafting, it can help doctors to choose the optimal operation method. Methods In this study, the modeling and simulation method of multi-scaled model of coronary had been designed. The 3D model of the bypass surgery region is constructed by the 3D reconstruction of the patient's medical imaging and the virtual bypass surgery. The individuation lumped parameter model is constructed by the basic physiological information of the patients. Finally, the two models are connected by a special boundary surface coupling algorithm to construct a 0D-3D coupled multi-scaled model that can be used to calculate the hemodynamic environment. Through calculation, the flow waveform, wall shear stress(WSS), oscillating shear index(OSI) and other hemodynamic parameters in the graft under different bypass methods were compared, and the optimal operation method with the best hemodynamic environment was selected. Results The method was used to calculate two clinical cases, and the effectiveness of the method was proved by the comparison of calculated graft flow and real graft flow, and the comparison of hemodynamic environment and graft outcomes after one year. Conclusion This method can realize preoperative evaluation of the hemodynamic environment of the graft under different bypass methods, and then select the optimal operation method for the patients and improve the graft patency after operation.