Computational analysis of the hemodynamic performance of novel endovascular and surgical procedures for complex aortic diseases
Creators: name: Zhu, Yu
Publisher: name: Imperial College London
Year: 2020

description: Novel branched stent-grafts (BSG) have been developed for endovascular repair of complex thoracic aortic aneurysms (TAA) involving the aortic arch or thoracoabdominal aorta, but their haemodynamic performance has not been adequately studied. In addition, surgical replacement of the ascending aorta with a Dacron graft remains the gold standard for type A aortic dissection (TAAD), although 12% of patients are at risk of aortic rupture due to further dilatation of the residual dissected aorta. The underlying mechanisms for progressive aortic dilatation following TAAD repair are poorly understood, but haemodynamic and biomechanical factors are believed to play an important role. Therefore, the present study aims to provide more insights into the haemodynamics in novel BSGs developed for treating complex aortic diseases, and a comprehensive evaluation of flow and biomechanical conditions in post-surgery TAADs by means of state-of-the-art computational methods. The first part of this thesis focuses on evaluating the haemodynamic performance of novel BSG designs, including thoracoabdominal branch endoprosthesis (TAMBE) and dual-branched thoracic endograft. Haemodynamics in idealised and patient-specific BSG models has been analysed by examining side branch outflow waveforms, wall shear stress related indices, and displacement forces, in order to assess their long-term durability. The numerical results show that all the stent-graft models examined in this study are capable of providing normal blood perfusion to side vessels, and are at low risk of in-stent thrombosis and device migration. Furthermore, it has been shown that geometric variations in TAMBE do not affect the key haemodynamic results, indicating its potential suitability for a variety of visceral artery anatomies. Comparisons of dual-branched thoracic endograft models with different inner tunnel diameters suggest that BSGs with larger inner tunnel diameters than the respective vessels would be preferred. Comparisons between the pre- and post-intervention models show that insertion of a dual-branched stent-graft significantly alters the flow pattern in the aortic arch, some of which may have a detrimental effect in the long term, thus requiring follow-up studies. The second part of the thesis provides a comprehensive analysis of the haemodynamic and biomechanical conditions in surgically repaired TAAD. Geometric and haemodynamic parameters have been analyzed and compared between the group of patients with stable aortic diameter and another group with progressive aortic dilatation. The number of re-entry tears (6±5 vs 2±1;P= 0.02) and luminal pressure difference (1.3 ±1 vs 11.7 ±14.6 mmHg;P= 0.001) have been identified as potential predictors of progressive aortic dilatation in TAAD patients following surgical repair. This is an important finding and can potentially assist clinicians to make the most appropriate choice or surgical plan for individual patients. Based on the finite element analysis of four patient-specific cases, there are no clear differences in biomechanical parameters between the stable and unstable groups. Furthermore, a preliminary fluid-solid interaction (FSI) simulation performed on a single TAAD model has demonstrated the important influence of wall compliance on pressures in the true and false lumen. Compared to a rigid wall model, the FSI simulation results show a reduction in systolic pressure by up to 10 mmHg and a slight increase in diastolic pressure. However, pressures in the true and false lumen are affected in the same way, so that the luminal pressure difference remains the same between the rigid and FSI models.