P024. A Systematic Quantification of Hemodynamic Differences Persisting After Aortic Coarctation Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Duke University Medical Center
Durham, NC
United States - Contact Me
Dr. Christopher Jensen is a general surgery resident and currently an AHA Postdoctoral Fellow in the Randles Laboratory at Duke University. His research interests include the application of computational fluid dynamics to questions in cardiac surgery, as well as a variety of clinical outcomes research in adult cardiac surgery. He received his MD and Master's in Epidemiology/Biostatistics from Stanford University in 2019, and his BA in Astrophysics and Physics from Harvard University in 2012. He is originally from New York City, and in his free time enjoys running, backpacking, stargazing, and no-limit poker.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.