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Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model

(2010) CARDIOVASCULAR RESEARCH. 88(3). p.512-519
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Abstract
Competitive flow from native coronary vessels is considered a major factor in the failure of coronary bypass grafts. However, the pathophysiological effects are not fully understood. Low and oscillatory wall shear stress (WSS) is known to induce endothelial dysfunction and vascular disease, like atherosclerosis and intimal hyperplasia. The aim was to investigate the impact of competitive flow on WSS in mammary artery bypass grafts. Using computational fluid dynamics, WSS was calculated in a left internal mammary artery (LIMA) graft to the left anterior descending artery in a three-dimensional in vivo porcine coronary artery bypass graft model. The following conditions were investigated: high competitive flow (non-significant coronary lesion), partial competitive flow (significant coronary lesion), and no competitive flow (totally occluded coronary vessel). Time-averaged WSS of LIMA at high, partial, and no competitive flow were 0.3-0.6, 0.6-3.0, and 0.9-3.0 Pa, respectively. Further, oscillatory WSS quantified as the oscillatory shear index (OSI) ranged from (maximum OSI = 0.5 equals zero net WSS) 0.15 to 0.35, < 0.05, and < 0.05, respectively. Thus, high competitive flow resulted in substantial oscillatory and low WSS. Moderate competitive flow resulted in WSS and OSI similar to the no competitive flow condition. Graft flow is highly dependent on the degree of competitive flow. High competitive flow was found to produce unfavourable WSS consistent with endothelial dysfunction and subsequent graft narrowing and failure. Partial competitive flow, however, may be better tolerated as it was found to be similar to the ideal condition of no competitive flow.
Keywords
Competitive flow, CABG, Wall shear stress, Graft patency, Computational fluid dynamics, INTERNAL THORACIC ARTERY, BYPASS GRAFT DISEASE, TERM PATENCY, STENOSIS, VIVO, ATHEROSCLEROSIS, SEVERITY, PATTERNS, INTERMEDIATE

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Citation

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Chicago
Nordgaard, Havard , Abigaïl Swillens, Dag Nordhaug, Idar Kirkeby-Garstad, Denis Van Loo, Nicola Vitale, Patrick Segers, Rune Haverstaad, and Lasse Lovstakken. 2010. “Impact of Competitive Flow on Wall Shear Stress in Coronary Surgery: Computational Fluid Dynamics of a LIMA-LAD Model.” Cardiovascular Research 88 (3): 512–519.
APA
Nordgaard, H., Swillens, A., Nordhaug, D., Kirkeby-Garstad, I., Van Loo, D., Vitale, N., Segers, P., et al. (2010). Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model. CARDIOVASCULAR RESEARCH, 88(3), 512–519.
Vancouver
1.
Nordgaard H, Swillens A, Nordhaug D, Kirkeby-Garstad I, Van Loo D, Vitale N, et al. Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model. CARDIOVASCULAR RESEARCH. 2010;88(3):512–9.
MLA
Nordgaard, Havard , Abigaïl Swillens, Dag Nordhaug, et al. “Impact of Competitive Flow on Wall Shear Stress in Coronary Surgery: Computational Fluid Dynamics of a LIMA-LAD Model.” CARDIOVASCULAR RESEARCH 88.3 (2010): 512–519. Print.
@article{1147153,
  abstract     = {Competitive flow from native coronary vessels is considered a major factor in the failure of coronary bypass grafts. However, the pathophysiological effects are not fully understood. Low and oscillatory wall shear stress (WSS) is known to induce endothelial dysfunction and vascular disease, like atherosclerosis and intimal hyperplasia. The aim was to investigate the impact of competitive flow on WSS in mammary artery bypass grafts.
Using computational fluid dynamics, WSS was calculated in a left internal mammary artery (LIMA) graft to the left anterior descending artery in a three-dimensional in vivo porcine coronary artery bypass graft model. The following conditions were investigated: high competitive flow (non-significant coronary lesion), partial competitive flow (significant coronary lesion), and no competitive flow (totally occluded coronary vessel). Time-averaged WSS of LIMA at high, partial, and no competitive flow were 0.3-0.6, 0.6-3.0, and 0.9-3.0 Pa, respectively. Further, oscillatory WSS quantified as the oscillatory shear index (OSI) ranged from (maximum OSI = 0.5 equals zero net WSS) 0.15 to 0.35, {\textlangle} 0.05, and {\textlangle} 0.05, respectively. Thus, high competitive flow resulted in substantial oscillatory and low WSS. Moderate competitive flow resulted in WSS and OSI similar to the no competitive flow condition.
Graft flow is highly dependent on the degree of competitive flow. High competitive flow was found to produce unfavourable WSS consistent with endothelial dysfunction and subsequent graft narrowing and failure. Partial competitive flow, however, may be better tolerated as it was found to be similar to the ideal condition of no competitive flow.},
  author       = {Nordgaard, Havard  and Swillens, Abiga{\"i}l and Nordhaug, Dag  and Kirkeby-Garstad, Idar and Van Loo, Denis and Vitale, Nicola and Segers, Patrick and Haverstaad, Rune and Lovstakken, Lasse},
  issn         = {0008-6363},
  journal      = {CARDIOVASCULAR RESEARCH},
  keyword      = {Competitive flow,CABG,Wall shear stress,Graft patency,Computational fluid dynamics,INTERNAL THORACIC ARTERY,BYPASS GRAFT DISEASE,TERM PATENCY,STENOSIS,VIVO,ATHEROSCLEROSIS,SEVERITY,PATTERNS,INTERMEDIATE},
  language     = {eng},
  number       = {3},
  pages        = {512--519},
  title        = {Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model},
  url          = {http://dx.doi.org/10.1093/cvr/cvq210},
  volume       = {88},
  year         = {2010},
}

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