Mild Anastomotic Stenosis in Patient-Specific CABG Model May Enhance Graft Patency: A New Hypothesis

Yunlong Huo, Tong Luo, Julius M. Guccione, Shawn D. Teague, Wenchang Tan, José A. Navia, Ghassan S. Kassab

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15 Scopus citations

Abstract

It is well known that flow patterns at the anastomosis of coronary artery bypass graft (CABG) are complex and may affect the long-term patency. Various attempts at optimal designs of anastomosis have not improved long-term patency. Here, we hypothesize that mild anastomotic stenosis (area stenosis of about 40-60%) may be adaptive to enhance the hemodynamic conditions, which may contribute to slower progression of atherosclerosis. We further hypothesize that proximal/distal sites to the stenosis have converse changes that may be a risk factor for the diffuse expansion of atherosclerosis from the site of stenosis. Twelve (12) patient-specific models with various stenotic degrees were extracted from computed tomography images using a validated segmentation software package. A 3-D finite element model was used to compute flow patterns including wall shear stress (WSS) and its spatial and temporal gradients (WSS gradient, WSSG, and oscillatory shear index, OSI). The flow simulations showed that mild anastomotic stenosis significantly increased WSS (>15 dynes{dot operator}cm-2) and decreased OSI (<0.02) to result in a more uniform distribution of hemodynamic parameters inside anastomosis albeit proximal/distal sites to the stenosis have a decrease of WSS (<4 dynes{dot operator}cm-2). These findings have significant implications for graft adaptation and long-term patency.

Original languageEnglish (US)
Article numbere73769
JournalPloS one
Volume8
Issue number9
DOIs
StatePublished - Sep 13 2013

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Huo, Y., Luo, T., Guccione, J. M., Teague, S. D., Tan, W., Navia, J. A., & Kassab, G. S. (2013). Mild Anastomotic Stenosis in Patient-Specific CABG Model May Enhance Graft Patency: A New Hypothesis. PloS one, 8(9), [e73769]. https://doi.org/10.1371/journal.pone.0073769