28.11.2023 | Review
Effect of Virtual Aortic Arch Reconstruction After Norwood Procedure on Cardiac Function, Energy Efficiency, and Wall Shear Stress from Multiscale Simulations
Current Cardiovascular Imaging Reports
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Purpose of Review
The current in silico study features a patient who underwent Norwood arch reconstruction to compare hemodynamic and energy-based indices between the image-based pre-operative reconstructed geometry (i.e., Pre-op) and a virtual post-operative reconstruction (i.e., Post-op). We hypothesized that the Post-op geometry would be associated with decreased afterload and increased stroke volume, consequently leading to a decrease in single ventricle workload as well as more favorable hemodynamic indices (i.e., decreased oscillatory shear index (OSI) and increased time-averaged wall shear stress (TAWSS)), particularly within the reconstructed region.
Computational modeling can facilitate assessment of energy and hemodynamic alterations for difficult surgical procedures including the Norwood operation where outcomes remain suboptimal with high interstage mortality and frequent reoperations.
A patient-specific computational fluid dynamics (CFD) model was created from cardiac magnetic resonance imaging, blood flow, and blood pressure data. Virtual reconstruction was implemented based on surgeon and clinician input. Resulting simulations incorporated downstream vascular resistance and compliance to replicate patient physiology using 3-element Windkessel representations to quantify TAWSS and OSI locally. A closed-loop heart model was used to determine global differences in energy efficiency (Eeff), energy loss (EL), and cardiac workload. WSS indices generally improved with virtual arch geometry reconstruction, which resulted in only modest changes in EL, Eeff, and cardiac workload. A framework to implement and compare virtual arch reconstruction is presented. Results show that more drastic changes in geometry may need to be implemented if the virtual reconstruction is to yield a significant impact on indices of cardiac function.