Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models

Authors

Jacqueline Contento, Department of Cardiology, Children's National Hospital, Washington, DC.
Paige Mass, Department of Cardiology, Children's National Hospital, Washington, DC.
Vincent Cleveland, Department of Cardiology, Children's National Hospital, Washington, DC.Follow
Seda Aslan, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md.Follow
Hiroshi Matsushita, Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill.
Hidenori Hayashi, Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill.
Vivian Nguyen, Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill.
Keigo Kawaji, Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill.
Yue-Hin Loke, Department of Cardiology, Children's National Hospital, Washington, DC.
Kevin Nelson, Nanofiber Solutions, LLC, Dublin, Ohio.
Jed Johnson, Nanofiber Solutions, LLC, Dublin, Ohio.
Axel Krieger, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md.
Laura Olivieri, Department of Cardiology, Children's National Hospital, Washington, DC.
Narutoshi Hibino, Advocate Aurora HealthFollow

Recommended Citation

Contento J, Mass P, Cleveland V, et al. Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models. JTCVS Open. 2022;12:355-363. Published 2022 Aug 24. doi:10.1016/j.xjon.2022.08.006

Affiliations

Advocate Children's Hospital

Abstract

Objective: Although surgical simulation using computational fluid dynamics has advanced, little is known about the accuracy of cardiac surgical procedures after patient-specific design. We evaluated the effects of discrepancies in location for patient-specific simulation and actual implantation on hemodynamic performance of patient-specific tissue-engineered vascular grafts (TEVGs) in porcine models.

Methods: Magnetic resonance angiography and 4-dimensional (4D) flow data were acquired in porcine models (n = 11) to create individualized TEVGs. Graft shapes were optimized and manufactured by electrospinning bioresorbable material onto a metal mandrel. TEVGs were implanted 1 or 3 months postimaging, and postoperative magnetic resonance angiography and 4D flow data were obtained and segmented. Displacement between intended and observed TEVG position was determined through center of mass analysis. Hemodynamic data were obtained from 4D flow analysis. Displacement and hemodynamic data were compared using linear regression.

Results: Patient-specific TEVGs were displaced between 1 and 8 mm during implantation compared with their surgically simulated, intended locations. Greater offset between intended and observed position correlated with greater wall shear stress (WSS) in postoperative vasculature (P < .01). Grafts that were implanted closer to their intended locations showed decreased WSS.

Conclusions: Patient-specific TEVGs are designed for precise locations to help optimize hemodynamic performance. However, if TEVGs were implanted far from their intended location, worse WSS was observed. This underscores the importance of not only patient-specific design but also precision-guided implantation to optimize hemodynamics in cardiac surgery and increase reproducibility of surgical simulation.

Document Type

Article

PubMed ID

36590712