Numerical Simulation of Thrombus Formation after Distal-End Side-to-Side Anastomosisfor Coronary Artery Bypass Grafting
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    Abstract:

    Objective The use of distal-end side-to-side anastomosis for coronary artery bypass grafting, thrombus will be generated at the distal end of the graft, which may cause adverse events. Some clinical doctors cut the partial distal ends of the graft, and some keep the shape of the distal end of the graft unchanged. This article will study the difference in thrombus formation of the distal end of the graft with two different treatments for the distal end of graft. Methods For the distal-end side-to-side anastomosis coronary artery bypass grafting, two models were constructed. Distal end of the graft of one model was cut and the other wasn’t. Using hemodynamics combined with a blood substance transport and diffusion model that considers biochemical reactions, the parameters of shear rate, fluid residence time, and platelet distribution are used to evaluate the possibility of thrombus formation for a DESSA of coronary artery. Results For the model with no cutting treatment at the distal end of the graft, the thrombus is first formed on the inner wall of the distal end of the graft, and then grows inward until the thrombus occupies the most region of the graft. This means the formation of a stable thrombus, and the volume of the thrombus doesn’t change. Its volume is 15.05mm3. For the model with cutting treatment at the distal end of the graft, the final volume of the thrombus is 7.35mm3, which is 51.2% less than that of the model without distal end trimming of the graft. It is worth noting that thrombus is formed on the inner wall of the graft above the anastomosis for the model with distal end trimming of the graft, and the wall thickness is about 0.16 mm. Although 0.16mm is small, its value is 10.65% of the radius of the graft (1.50mm). In the above two procedures, multiple vortices (less than 0.01m/s) were formed in the distal region of the graft, which further promotes the thrombus formation in the distal end of the graft. The area of thrombus formation obtained from numerical simulation is consistent with the clinical investigation. Conclusion For clinical coronary artery bypass grafting with side-to-side anastomosis, the volume of the generated thrombus can be reduced for the model with the trimming of the distal end of the graft. However, the effect of thrombus formation on the inner wall of the graft above the anastomosis on coronary artery bypass graft needs further study.

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History
  • Received:July 12,2021
  • Revised:September 02,2021
  • Adopted:September 07,2021
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