In vitro testing of a newly developed arteriovenous double-outflow graft Michael Heise, MD, Petra Kirschner, MD, Antonius Rabsch, MD, Jürgen Zanow, MD,

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Presentation transcript:

In vitro testing of a newly developed arteriovenous double-outflow graft Michael Heise, MD, Petra Kirschner, MD, Antonius Rabsch, MD, Jürgen Zanow, MD, Utz Settmacher, MD, Christoph Heidenhain, MD Journal of Vascular Surgery Volume 52, Issue 2, Pages 421-428 (August 2010) DOI: 10.1016/j.jvs.2010.03.019 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 In this schematic drawing of the Bi-Flow graft design, the arterial part consists of a straight polytetrafluoroethylene sheet, which widens to a venous diffuser. A flow baffle is used inside the diffuser portion to divide the outflow section into two flow channels. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Hardcopy of the software used to create the 3-dimensional models that were eventually used for the computerized numerical control milling machine. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Image shows the finished silastic model of the small Bi-Flow graft. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Particle image velocimetry provides reconstruction images of the velocity fields obtained representing the 350-millisecond time step during systole. The flow main stream was fully developed. Large separation areas were present in the Venaflo as well as in the diffuser grafts. A laminar flow pattern was visible within the Bi-Flow grafts inside the double channels. However, separation areas developed in the large Bi-Flow model due to the broad widening. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Sheer stresses were calculated in the graft vein junction at the 150-, 250-, and 350-millisecond time step of systole. Although particular high shear stresses were present in the straight end-to-side anastomosis, the shear forces in the remaining models were moderate and significantly lower compared with those in the straight graft anastomosis. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Comparison of flow rates through the silastic models. The systolic pressures of the Berlin Heart were stepwise increased, and the resulting volumetric flow rates were measured. The flow through the small Bi-Flow graft was 21% on average higher compared with the remaining models. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 7 The measured perfusion pressures showed decreased pressures in the small Bi-Flow model, while the highest pressures were found in the straight graft model. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 8 Comparison of the calculated peripheral resistances of the silastic models. The resistance of the small Bi-Flow model was markedly decreased. This finding could possibly explain the flow increase though this model. Journal of Vascular Surgery 2010 52, 421-428DOI: (10.1016/j.jvs.2010.03.019) Copyright © 2010 Society for Vascular Surgery Terms and Conditions