A Systematic Quantification of Hemodynamic Differences Persisting After Aortic Coarctation Repair
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0024
Submission Type:
Abstract Submission
Authors:
Christopher Jensen (1), Arash Ghorbannia (2), David Urick (2), G. Chad Hughes (1), Amanda Randles (2)
Institutions:
(1) Duke University Medical Center, Durham, NC, (2) Duke University, Durham, NC
Submitting Author:
Christopher Jensen
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Duke University Medical Center
Duke University Medical Center
Co-Author(s):
Arash Ghorbannia
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Duke University
Duke University
David Urick
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Duke University
Duke University
*G. Chad Hughes
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Duke University Medical Center
Duke University Medical Center
Amanda Randles
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Duke University
Duke University
Presenting Author:
Christopher Jensen
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Duke University Medical Center
Duke University Medical Center
Abstract:
Objective
Open repair of aortic coarctation has excellent short-term outcomes, but restenosis at the repair site is a long-term complication observed in up to 50% of patients. We hypothesized that residual hemodynamic abnormalities at the repair site may contribute to pathologic aortic remodeling and restenosis.
Methods
Six patients who underwent resection with end-to-end anastomosis for aortic coarctation underwent postoperative MRI angiography. Anatomically accurate models were generated for each patient. They were each compared to age- and sex-matched healthy control patients. Computational fluid dynamics (CFD) simulations were performed of the baseline geometries. Stenoses of 10%, 50%, and 80% were introduced at the repair site in each patient and control. Measured outcomes included blood flow and velocity, vorticity, time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI).
Results
Significant differences in TAWSS persist following CoA repair (Figure). Additionally, these differences increase significantly and nonlinearly with restenosis angle.
Conclusions
Significant hemodynamic differences persist following aortic coarctation repair. The nonlinear association of these differences with restenosis angle suggests a positive feedback mechanism. CFD investigations may be able to provide additional insight on patient-specific pathologic remodeling following CoA repair.
Open repair of aortic coarctation has excellent short-term outcomes, but restenosis at the repair site is a long-term complication observed in up to 50% of patients. We hypothesized that residual hemodynamic abnormalities at the repair site may contribute to pathologic aortic remodeling and restenosis.
Methods
Six patients who underwent resection with end-to-end anastomosis for aortic coarctation underwent postoperative MRI angiography. Anatomically accurate models were generated for each patient. They were each compared to age- and sex-matched healthy control patients. Computational fluid dynamics (CFD) simulations were performed of the baseline geometries. Stenoses of 10%, 50%, and 80% were introduced at the repair site in each patient and control. Measured outcomes included blood flow and velocity, vorticity, time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI).
Results
Significant differences in TAWSS persist following CoA repair (Figure). Additionally, these differences increase significantly and nonlinearly with restenosis angle.
Conclusions
Significant hemodynamic differences persist following aortic coarctation repair. The nonlinear association of these differences with restenosis angle suggests a positive feedback mechanism. CFD investigations may be able to provide additional insight on patient-specific pathologic remodeling following CoA repair.
Aortic Symposium:
Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)
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