ObjectiveThis study aimed to comprehensively examine the roles of size, location, and number of tears in the progression of surgically repaired type A aortic dissection (TAAD) by assessing haemodynamic changes through patient-specific computational fluid dynamic (CFD) simulations.MethodsTwo patient-specific TAAD geometries with replaced ascending aorta were reconstructed based upon computed 15 tomography (CT) scans, after which 10 hypothetical models (5 per patient) with different tear configurations were artificially created. CFD simulations were performed on all the models under physiologically realistic boundary conditions.ResultsOur simulation results showed that increasing either the size or number of the re-entry tears reduced the luminal pressure difference (LPD) and maximum time-averaged wall shear stress (TAWSS), as well as areas exposed to abnormally high or low TAWSS values. Models with a large re-entry tear outperformed the others by reducing the maximum LPD by 1.88 mmHg and 7.39 mmHg, for patients 1 and 2, respectively. Moreover, proximally located re-entry tears in the descending aorta were more effective at reducing LPD than distal re-entry tears.DiscussionThese computational results indicate that the presence of a relatively large re-entry tear in the proximal descending aorta might help stabilize post-surgery aortic growth. This finding has important implications for the management and risk stratification of surgically repaired TAAD patients. Nevertheless, further validation in a large patient cohort is needed.
This study aimed to predict the hemodynamic performance of frozen elephant trunk (FET) intervention in surgically repaired type A aortic dissection (TAAD) patients through computational simulations of post-operative scenarios. Patient-specific geometries of a single patient were reconstructed from pre- and post-FET intervention computed tomography angiography (CTA) images. The pre-FET geometry was used to create post-FET geometry through anatomical modifications and a simplified finite element simulation to inflate the stented true lumen (TL) segment. Computational fluid dynamics (CFD) simulations were then performed on the virtually created post-FET geometry, and the results were compared with those obtained with the actual post-FET geometry. Various intervention scenarios with different stent-graft (SG) lengths and TL volume expansion were also simulated and compared to study their impacts on hemodynamic performance. A good overall agreement was achieved between the virtual and real post-FET models, with the maximum difference in true and false lumen (FL) pressures along the dissected aorta being 4.2%. Simulation results for the actual intervention revealed high wall shear stress (WSS) and pressure around a distal tear that was found to have expanded on post-FET scan. Extending the SG length dramatically reduced the maximum WSS and pressure around the distal tear. This pilot study demonstrates the feasibility of using the simplified simulation workflow for personalized assessment of aortic hemodynamics following FET intervention in repaired TAAD. Further studies in a large patient cohort are warranted.
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