Hemodynamic numerical simulation of aortic arch modular inner branched stent-graft in eight early patients from the first-in-human case series

Yating Zhu; Fen Li; Hongpeng Zhang; Hui Song; Xiaodan Ma; Long Cao; Wenjun Zhang; Wei Guo

doi:10.3389/fcvm.2022.981546

Hemodynamic numerical simulation of aortic arch modular inner branched stent-graft in eight early patients from the first-in-human case series

Front Cardiovasc Med. 2022 Aug 30:9:981546. doi: 10.3389/fcvm.2022.981546. eCollection 2022.

Authors

Yating Zhu¹, Fen Li², Hongpeng Zhang¹, Hui Song², Xiaodan Ma³, Long Cao⁴, Wenjun Zhang⁵, Wei Guo¹

Affiliations

¹ Department of Vascular Surgery, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
² College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan, China.
³ Equipment Department, The Fourth People's Hospital of Taiyuan, Taiyuan, China.
⁴ Department of General Surgery, People's Liberation Army No. 983 Hospital, Tianjin, China.
⁵ Department of Ultrasonic Diagnosis, People's Liberation Army No. 980 Hospital, Shijiazhuang, China.

Abstract

Background: The modular inner branched stent-graft (MIBSG) (WeFlow-Arch™) is an emerging device for challenging aortic arch pathologies. Hemodynamic numerical simulation is conducive to predicting long-term outcomes as well as optimizing the stent-graft design.

Objective: This study aims to analyze the hemodynamic characteristics of the MIBSG devices based on numerical simulation analyses.

Methods: From June 2019 to June 2021, MIBSGs were utilized in eight cases. Numerical simulation analyses of branch perfusion and indicators including the time-averaged wall shear stress, oscillatory shear index, and relative residence time were performed.

Results: Lesions involved Zone 1 (n = 2), Zone 2 (n = 4), and Zone 3 (n = 2). Branched stent-grafts were deployed in the innominate artery and left common carotid artery (n = 5) or in the innominate artery and left subclavian artery (n = 3). The hemodynamic change in common was increased perfusion in the descending aorta and left common carotid artery. Half of the patients had increased cerebral perfusion of 8.7% at most, and the other half of the patients showed a reduction of 5.3% or less. Case 3 was considered to have acquired the greatest improvement in hemodynamic features.

Conclusion: The MIBSG showed improved hemodynamic features in most cases. The design of the MIBSG could be partly modified to acquire better hemodynamic performance.

Keywords: aortic arch; hemodynamics; inner branched stent-graft; numerical simulation; thoracic endovascular aortic repair (TEVAR); thoracic stent-graft.