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Multilayer flow modulator enhances vital organ perfusion in patients with type B aortic dissection

Rikhtegar Nezami, Farhad and Athanasiou, Lambros S. and Amrute, Junedh M. and Edelman, Elazer R. (2018) Multilayer flow modulator enhances vital organ perfusion in patients with type B aortic dissection. American Journal of Physiology - Heart and Circulatory Physiology, 315 (5). H1182-H1193. ISSN 0363-6135. https://resolver.caltech.edu/CaltechAUTHORS:20190103-153505209

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Abstract

Management of aortic dissections (AD) is still challenging, with no universally approved guideline among possible surgical, endovascular, or medical therapies. Approximately 25% of patients with AD suffer postintervention malperfusion syndrome or hemodynamic instability, with the risk of sudden death if left untreated. Part of the issue is that vascular implants may themselves induce flow disturbances that critically impact vital organs. A multilayer mesh construct might obviate the induced flow disturbances, and it is this concept we investigated. We used preintervention and post-multilayer flow modulator implantation (PM) geometries from clinical cases of type B AD. In-house semiautomatic segmentation routines were applied to computed tomography images to reconstruct the lumen. The device was numerically reconstructed and adapted to the PM geometry concentrically fit to the true lumen centerline. We also numerically designed a pseudohealthy case, where the geometry of the aorta was extracted interpolating geometric features of preintervention, postimplantation, and published representative healthy volunteers. Computational fluid dynamics methods were used to study the time-dependent flow patterns, shear stress metrics, and perfusion to vital organs. A three-element Windkessel lumped parameter module was coupled to a finite-volume solver to assign dynamic outlet boundary conditions. Multilayer flow modulator not only significantly reduced false lumen blood flow, eliminated local flow disturbances, and globally regulated wall shear stress distribution but also maintained physiological perfusion to peripheral vital organs. We propose further investigation to focus the management of AD on both modulation of blood flow and restoration of physiologic end-organ perfusion rather than mere restoration of vascular lamina morphology.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.1152/ajpheart.00199.2018DOIArticle
ORCID:
AuthorORCID
Rikhtegar Nezami, Farhad0000-0002-4210-3177
Additional Information:© 2018 the American Physiological Society. Received 22 March 2018. Accepted 2 August 2018. Published online 15 October 2018. Published in print 1 November 2018. E. Edelman and F. Rikhtegar Nezami were funded in part by National Institutes of Health Grant R01-GM-49039. AUTHOR CONTRIBUTIONS: F.R.N., L.S.A., and E.R.E. conceived and designed research; F.R.N., L.S.A., and J.M.A. performed experiments; F.R.N., L.S.A., and J.M.A. analyzed data; F.R.N. and E.R.E. interpreted results of experiments; F.R.N. prepared figures; F.R.N. and J.M.A. drafted manuscript; F.R.N., L.S.A., J.M.A., and E.R.E. edited and revised manuscript; F.R.N., L.S.A., J.M.A., and E.R.E. approved final version of manuscript. DISCLOSURES: Cardiatis provided access to data and partial funding for L. Athanasiou.
Funders:
Funding AgencyGrant Number
NIHR01 GM49039
Subject Keywords:aortic dissection; flow rate; malperfusion; multilayer flow modulator
Issue or Number:5
Record Number:CaltechAUTHORS:20190103-153505209
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20190103-153505209
Official Citation:Multilayer flow modulator enhances vital organ perfusion in patients with type B aortic dissection Farhad Rikhtegar Nezami, Lambros S. Athanasiou, Junedh M. Amrute, and Elazer R. Edelman American Journal of Physiology-Heart and Circulatory Physiology 2018 315:5, H1182-H1193
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:92060
Collection:CaltechAUTHORS
Deposited By: George Porter
Deposited On:03 Jan 2019 23:59
Last Modified:03 Oct 2019 20:40

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