Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine modelsCentral MessagePerspective
Jacqueline Contento, BSE,
Paige Mass, BS,
Vincent Cleveland, MS,
Seda Aslan, MS,
Hiroshi Matsushita, MD,
Hidenori Hayashi, MD,
Vivian Nguyen, PhD,
Keigo Kawaji, PhD,
Yue-Hin Loke, MD,
Kevin Nelson, PhD,
Jed Johnson, PhD,
Axel Krieger, PhD,
Laura Olivieri, MD,
Narutoshi Hibino, MD, PhD
Affiliations
Jacqueline Contento, BSE
Department of Cardiology, Children's National Hospital, Washington, DC
Paige Mass, BS
Department of Cardiology, Children's National Hospital, Washington, DC
Vincent Cleveland, MS
Department of Cardiology, Children's National Hospital, Washington, DC
Seda Aslan, MS
Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md
Hiroshi Matsushita, MD
Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
Hidenori Hayashi, MD
Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
Vivian Nguyen, PhD
Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill
Keigo Kawaji, PhD
Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill
Yue-Hin Loke, MD
Department of Cardiology, Children's National Hospital, Washington, DC
Kevin Nelson, PhD
Nanofiber Solutions, LLC, Dublin, Ohio
Jed Johnson, PhD
Nanofiber Solutions, LLC, Dublin, Ohio
Axel Krieger, PhD
Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md
Laura Olivieri, MD
Department of Cardiology, Children's National Hospital, Washington, DC
Narutoshi Hibino, MD, PhD
Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill; Department of Cardiovascular Surgery, Advocate Children's Hospital, Oak Lawn, Ill; Address for reprints: Narutoshi Hibino, MD, PhD, Section of Cardiac Surgery, Department of Surgery, The University of Chicago, Advocate Children's Hospital, 5841 S Maryland Ave, Room E500B, MC5040, Chicago, IL 60637.
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.
