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Patient-specific fluid–structure interaction simulation of the LAD-ITA bypass graft for moderate and severe stenosis: A doubt on the fractional flow reserve-based decision

Tajeddini, F ; Sharif University of Technology | 2022

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  1. Type of Document: Article
  2. DOI: 10.1016/j.bbe.2021.12.003
  3. Publisher: Elsevier B.V , 2022
  4. Abstract:
  5. Fractional flow reserve (FFR)-based decision improves the outcomes of percutaneous coronary intervention (PCI) for some patients, while its effectiveness in improving the results of coronary artery bypass graft (CABG) is unclear, in particular for moderate stenosis. It may be due to the fact that FFR cannot take into account the impacts of competitive flow (CF), intimal hyperplasia (IH), as well as compliance mismatch (CMM). As a result, two questions arise 1) whether FFR is a sufficient factor to decide to perform the CABG for patients with moderate to severe stenosis or not and 2) whether post-operative FFR shows the effectiveness of a graft. To shed light on this matter, two patient-specific models of LAD-ITA graft, consisting of two different severities of stenosis (moderate and severe), were simulated using two-way FSI simulation. It was observed that although both pre- and post-operative FFRs for moderate stenosis were higher, CF is more intense for moderate stenosis than severe one. Also, it was seen that CM and IH are more likely to occur in the bed, toe, and heel areas of a bypass graft performed for moderate stenosis. All in all, it can be concluded that in the case of moderate stenosis, pre- and post-operative FFRs might not be a suitable index for making the decision about performing or deferring CABG and also the effectiveness of the graft. Under such circumstances, it seems rational to use CFD in a wider range to investigate patients with moderate stenosis before the operation. © 2021 Nalecz Institute of Biocybernetics and Biomedical Engineering of the Polish Academy of Sciences
  6. Keywords:
  7. CABG ; Competitive flow ; Compliance mismatch ; FFR ; FSI ; String phenomenon ; Artery intima proliferation ; Blood flow velocity ; Computed tomographic angiography ; Coronary artery blood flow ; Coronary artery bypass graft ; Finite element analysis ; Fractional flow reserve ; Geometry ; Heart cycle ; Hemodynamics ; Human ; hyperplasia ; Pressure gradient ; Shear stress ; Stenosis
  8. Source: Biocybernetics and Biomedical Engineering ; Volume 42, Issue 1 , 2022 , Pages 143-157 ; 02085216 (ISSN)
  9. URL: https://www.sciencedirect.com/science/article/abs/pii/S0208521621001327