Research

Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

Thomas Frauenfelder¹ , Evangelos Boutsianis² , Thomas Schertler¹ , Lars Husmann¹ , Sebastian Leschka¹ , Dimos Poulikakos² , Borut Marincek¹ and Hatem Alkadhi¹

¹  Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland

²  Laboratory of Thermodynamics in Emerging Technologies, ETH Zurich, Zurich, Switzerland

author email corresponding author email

BioMedical Engineering OnLine 2007, 6:35doi:10.1186/1475-925X-6-35

Published:	26 September 2007

Abstract

Purpose

Coronary artery bypass graft (CABG) surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS), in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD).

Methods

One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT). Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized.

Results

CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle.

Conclusion

CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis warranting further systematic application of the presented methodology on multiple patient datasets.