ON FLOW DYNAMICS IN TYPE B AORTIC DISSECTION (TBAD)
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1 ON FLOW DYNAMICS IN TYPE B AORTIC DISSECTION (TBAD) A. Rabin 1, R. Karmeli 1, P. Bar-Yoseph 2 1- Vascular & Endovascular surgery department Hadassah university hospital, Jerusalem, Israel 2- Mechanical engineering Technion, Haifa, Israel Feb. 2018
2 DISCLOSURES The study is supported by Cardiatis
3 AORTIC DISSECTION Separation of the intima from the media Blood flows into the new false lumen Division of the aorta into 2 lumens Poor prognosis high mortality Immediate & long-term complications Rupture Aneurysm Ischemia
4 TYPE B AORTIC DISSECTION
5 TYPE B AORTIC DISSECTION Treatment Medical first ß-blockers, ICU Endovascular Stentgraft, minimal coverage, entry tear closure, false lumen full thrombosis expected Open surgery last resort, in case of complications, poor outcome
6 TBAD EXAMPLES
7 TBAD EXAMPLES
8 TBAD EXAMPLES
9 TBAD EXAMPLES
10 TBAD EXAMPLES
11 TBAD EXAMPLES
12 TBAD EXAMPLES
13 TBAD EXAMPLES
14 TBAD EXAMPLES
15 TBAD EXAMPLES Is it really the same disease for all cases?
16 WHAT DO WE KNOW SO FAR ABOUT TBAD? Acute event with chronic sequela and poor prognosis Anatomical variation Hemodynamic changes influence is unclear Surgical and Endovascular interventions have limited success
17 WHAT DO WE KNOW SO FAR ABOUT TBAD? Preventive treatment is controversial Decision made according to maximal diameter Animal models are difficult to produce and to validate In-vitro models are complex and limited
18 AND SO HOUSTON, WE HAVE A PROBLEM
19 COMPUTATIONAL FLUID DYNAMICS (CFD) Mathematical description of flow An engineering tool used in a clinical context Collaboration is a key factor Validation is needed
20 COMPUTATIONAL FLUID DYNAMICS (CFD) Flexible modeling taking into account many different parameters All parameters can be controlled and changed The model can be simplified to reduce computational and time resources Higher complexity and resolution is possible
21 CFD FOR TYPE B AORTIC DISSECTION Geometry Idealized benchmark model Patient specific geometry 2D simplified model Patient specific geometry CTA or MRA based models Differences in geometry Patient geometry evolution over time and the causative factors What leads to clinical stabilization?
22 CFD FOR TYPE B AORTIC DISSECTION Meshing Smoothing and cleaning are crucial Unified mesh vs. Separation of the 2 lumens Recreation of the entry & re-entry tears Solver Commercial vs. in-house code Different flow regimes steady state, transitional, turbulent Large-Eddy Simulation (LES)
23 CFD FOR TYPE B AORTIC DISSECTION Boundary conditions In-vivo measurements 4D MRI, Duplex, Echo, Catheterization Reduced order models (0D-1D) Constant velocity or pressure vs. Complex cardiac cycle variations
24 CFD FOR TYPE B AORTIC DISSECTION
25 CFD FOR TYPE B AORTIC DISSECTION Post-processing Identifying suspicious areas Turbulence, Wall shear-stress, diminished flow Putting the results into clinical context Fluid-structure interactions (FSI) Flexible wall Allowing intimal flap movement
26 EXAMPLES
27 CFD FOR TYPE B AORTIC DISSECTION Clinical applications Prognostic tool Comparing to clinical results Pre-procedure planning Re-evaluation of current medical treatment protocol
28 CARDIATIS MFM STENT
29 CFD IN ARCH AORTIC ANEURYSM (MFM)
30 CFD IN ARCH AORTIC ANEURYSM (MFM)
31 CFD IN ARCH AORTIC ANEURYSM (MFM)
32 CARDIATIS MFM STENT INFLUENCE Adding the stent into the CFD model Studying the stents influence on the hemodynamics Proving the lamination of flow
33 CFD FOR TYPE B AORTIC DISSECTION SUMMARY Clinical and engineering cooperation Multi-variables Validation Dissection is 3D, time related complexity Understanding initially the hemodynamics as the 1 st step towards solution Flow principals and considerations should be part of vascular training and daily routine
34 THANK YOU
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