Flow dynamics of the St Jude Medical Symmetry aortic connector vein graft anastomosis do not contribute to the risk of acute thrombosis A. Redaelli,

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Presentation transcript:

Flow dynamics of the St Jude Medical Symmetry aortic connector vein graft anastomosis do not contribute to the risk of acute thrombosis A. Redaelli, PhD, F. Maisano, MD, G. Ligorio, MS, E. Cattaneo, PhD, F.M. Montevecchi, MS, O. Alfieri, MD The Journal of Thoracic and Cardiovascular Surgery Volume 128, Issue 1, Pages 117-123 (July 2004) DOI: 10.1016/j.jtcvs.2004.02.039

Figure 1 The six 3-dimensional models featuring the ascending aorta with the aorta-coronary bypass. The 4 models on the left represent the hand-sewn anastomoses, and the angle between the graft axis and the aortic conduct is 45°, 90°, 135°, and 180°. The 2 models on the right represent the anastomoses performed with the aortic connector with respect to a standard case and a critical one. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 117-123DOI: (10.1016/j.jtcvs.2004.02.039)

Figure 2 Boundary conditions applied to the model. Qao, Aortic flow rate; Qbp, coronary by pass flow rate; Qcompl, aortic flow rate in the radial direction due to aortic wall compliance. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 117-123DOI: (10.1016/j.jtcvs.2004.02.039)

Figure 3 Fluid dynamics in the systolic phase (t = 0.06 s); a vortex occurred in the 6 models in this phase. The vortex is a consequence of the rapid change in direction of the fluid entering the graft. It is unavoidable in aorta-coronary bypass because of the necessity of executing the proximal anastomosis in the proximal aorta. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 117-123DOI: (10.1016/j.jtcvs.2004.02.039)

Figure 4 Fluid dynamics in the diastolic phase (t = 0.65 s); in the 4 models simulating the hand-sewn anastomoses, a vortex occurred close to the wall. This was not observed in the models that simulated the anastomoses performed with the aortic connector. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 117-123DOI: (10.1016/j.jtcvs.2004.02.039)

Figure 5 Schematic view of the toe and heel regions for the 6 models in which the wall shear stresses have been collected. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 117-123DOI: (10.1016/j.jtcvs.2004.02.039)

Figure 6 Wall shear stresses in the toe and heel regions during the diastolic phase (t = 0.65 s); in the 4 models simulating the hand-sewn anastomoses, both regions showed low wall shear stress values. The 2 models simulating the anastomoses performed with the aortic connection showed higher wall shear stress values in the heel region, as confirmed by the TAWSS and OSI index analysis (Table 2). The Journal of Thoracic and Cardiovascular Surgery 2004 128, 117-123DOI: (10.1016/j.jtcvs.2004.02.039)