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Shabbak A, Masoumkhani F, Fallah A, Amani-Beni R, Mohammadpour H, Shahbazi T, Bakhshi A. 3D Printing for Cardiovascular Surgery and Intervention: A Review Article. Curr Probl Cardiol 2024; 49:102086. [PMID: 37716537 DOI: 10.1016/j.cpcardiol.2023.102086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023]
Abstract
3D printing technology can be applied to practically every aspect of modern life, fulfilling the needs of people from various backgrounds. The utilization of 3D printing in the context of adult heart disease can be succinctly categorized into 3 primary domains: preoperative strategizing or simulation, medical instruction, and clinical consultations. 3D-printed model utilization improves surgical planning and intraoperative decision-making and minimizes surgical risks, and it has demonstrated its efficacy as an innovative educational tool for aspiring surgeons with limited practical exposure. Despite all the applications of 3D printing, it has not yet been shown to improve long-term outcomes, including safety. There are no data on the outcomes of controlled trials available. To appropriately diagnose heart disease, 3D-printed models of the heart can provide a better understanding of the intracardiac anatomy and provide all the information needed for operative planning. Experientially, 3D printing provides a wide range of perceptions for understanding lower extremity arteries' spatial geometry and anatomical features of pathology. Practicing cardiac surgery processes using objects printed using 3D imaging data can become the norm rather than the exception, leading to improved accuracy and quality of treatment. This study aimed to review the various applications of 3D printing technology in cardiac surgery and intervention.
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Affiliation(s)
- Ali Shabbak
- Research Committee, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Fateme Masoumkhani
- Department of cardiology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Fallah
- Research Committee, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hanieh Mohammadpour
- Research Committee, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Taha Shahbazi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Bakhshi
- Remember of Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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2
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Grande Gutiérrez N, Mukherjee D, Bark D. Decoding thrombosis through code: a review of computational models. J Thromb Haemost 2024; 22:35-47. [PMID: 37657562 PMCID: PMC11064820 DOI: 10.1016/j.jtha.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
From the molecular level up to a blood vessel, thrombosis and hemostasis involves many interconnected biochemical and biophysical processes over a wide range of length and time scales. Computational modeling has gained eminence in offering insights into these processes beyond what can be obtained from in vitro or in vivo experiments, or clinical measurements. The multiscale and multiphysics nature of thrombosis has inspired a wide range of modeling approaches that aim to address how a thrombus forms and dismantles. Here, we review recent advances in computational modeling with a focus on platelet-based thrombosis. We attempt to summarize the diverse range of modeling efforts straddling the wide-spectrum of physical phenomena, length scales, and time scales; highlighting key advancements and insights from existing studies. Potential information gleaned from models is discussed, ranging from identification of thrombus-prone regions in patient-specific vasculature to modeling thrombus deformation and embolization in response to fluid forces. Furthermore, we highlight several limitations of current models, future directions in the field, and opportunities for clinical translation, to illustrate the state-of-the-art. There are a plethora of opportunity areas for which models can be expanded, ranging from topics of thromboinflammation to platelet production and clearance. Through successes demonstrated in existing studies described here, as well as continued advancements in computational methodologies and computer processing speeds and memory, in silico investigations in thrombosis are poised to bring about significant knowledge growth in the years to come.
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Affiliation(s)
- Noelia Grande Gutiérrez
- Carnegie Mellon University, Department of Mechanical Engineering Pittsburgh, PA, USA. https://twitter.com/ngrandeg
| | - Debanjan Mukherjee
- University of Colorado Boulder, Paul M. Rady Department of Mechanical Engineering Boulder, CO, USA. https://twitter.com/debanjanmukh
| | - David Bark
- Washington University in St Louis, Department of Pediatrics, Division of Hematology and Oncology St Louis, MO, USA; Washington University in St Louis, Department of Biomedical Engineering St Louis, MO, USA.
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Tran-Nguyen N, Yan AT, Fremes S, Triverio P, Jimenez-Juan L. Abnormal Wall Shear Stress Area is Correlated to Coronary Artery Bypass Graft Remodeling 1 Year After Surgery. Ann Biomed Eng 2023:10.1007/s10439-023-03167-4. [PMID: 36871052 DOI: 10.1007/s10439-023-03167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/12/2023] [Indexed: 03/06/2023]
Abstract
Coronary artery bypass graft surgery is a common intervention for coronary artery disease; however, it suffers from graft failure, and the underlying mechanisms are not fully understood. To better understand the relation between graft hemodynamics and surgical outcomes, we performed computational fluid dynamics simulations with deformable vessel walls in 10 study participants (24 bypass grafts) based on CT and 4D flow MRI one month after surgery to quantify lumen diameter, wall shear stress (WSS), and related hemodynamic measures. A second CT acquisition was performed one year after surgery to quantify lumen remodeling. Compared to venous grafts, left internal mammary artery grafts experienced lower abnormal WSS (< 1 Pa) area one month after surgery (13.8 vs. 70.1%, p = 0.001) and less inward lumen remodeling one year after surgery (- 2.4% vs. - 16.1%, p = 0.027). Abnormal WSS area one month post surgery correlated with percent change in graft lumen diameter one year post surgery (p = 0.030). This study shows for the first time prospectively a correlation between abnormal WSS area one month post surgery and graft lumen remodeling 1 year post surgery, suggesting that shear-related mechanisms may play a role in post-operative graft remodeling and might help explain differences in failure rates between arterial and venous grafts.
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Affiliation(s)
- Nhien Tran-Nguyen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | - Andrew T Yan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen Fremes
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Piero Triverio
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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Schwarz EL, Pegolotti L, Pfaller MR, Marsden AL. Beyond CFD: Emerging methodologies for predictive simulation in cardiovascular health and disease. BIOPHYSICS REVIEWS 2023; 4:011301. [PMID: 36686891 PMCID: PMC9846834 DOI: 10.1063/5.0109400] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023]
Abstract
Physics-based computational models of the cardiovascular system are increasingly used to simulate hemodynamics, tissue mechanics, and physiology in evolving healthy and diseased states. While predictive models using computational fluid dynamics (CFD) originated primarily for use in surgical planning, their application now extends well beyond this purpose. In this review, we describe an increasingly wide range of modeling applications aimed at uncovering fundamental mechanisms of disease progression and development, performing model-guided design, and generating testable hypotheses to drive targeted experiments. Increasingly, models are incorporating multiple physical processes spanning a wide range of time and length scales in the heart and vasculature. With these expanded capabilities, clinical adoption of patient-specific modeling in congenital and acquired cardiovascular disease is also increasing, impacting clinical care and treatment decisions in complex congenital heart disease, coronary artery disease, vascular surgery, pulmonary artery disease, and medical device design. In support of these efforts, we discuss recent advances in modeling methodology, which are most impactful when driven by clinical needs. We describe pivotal recent developments in image processing, fluid-structure interaction, modeling under uncertainty, and reduced order modeling to enable simulations in clinically relevant timeframes. In all these areas, we argue that traditional CFD alone is insufficient to tackle increasingly complex clinical and biological problems across scales and systems. Rather, CFD should be coupled with appropriate multiscale biological, physical, and physiological models needed to produce comprehensive, impactful models of mechanobiological systems and complex clinical scenarios. With this perspective, we finally outline open problems and future challenges in the field.
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Affiliation(s)
- Erica L. Schwarz
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Luca Pegolotti
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Martin R. Pfaller
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Alison L. Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
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Patient-specific computational simulation of coronary artery bypass grafting. PLoS One 2023; 18:e0281423. [PMID: 36867601 PMCID: PMC9983828 DOI: 10.1371/journal.pone.0281423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/25/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Coronary artery bypass graft surgery (CABG) is an intervention in patients with extensive obstructive coronary artery disease diagnosed with invasive coronary angiography. Here we present and test a novel application of non-invasive computational assessment of coronary hemodynamics before and after bypass grafting. METHODS AND RESULTS We tested the computational CABG platform in n = 2 post-CABG patients. The computationally calculated fractional flow reserve showed high agreement with the angiography-based fractional flow reserve. Furthermore, we performed multiscale computational fluid dynamics simulations of pre- and post-CABG under simulated resting and hyperemic conditions in n = 2 patient-specific anatomies 3D reconstructed from coronary computed tomography angiography. We computationally created different degrees of stenosis in the left anterior descending artery, and we showed that increasing severity of native artery stenosis resulted in augmented flow through the graft and improvement of resting and hyperemic flow in the distal part of the grafted native artery. CONCLUSIONS We presented a comprehensive patient-specific computational platform that can simulate the hemodynamic conditions before and after CABG and faithfully reproduce the hemodynamic effects of bypass grafting on the native coronary artery flow. Further clinical studies are warranted to validate this preliminary data.
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Tran-Nguyen N, Condemi F, Yan A, Fremes S, Triverio P, Jimenez-Juan L. Wall Shear Stress Differences Between Arterial and Venous Coronary Artery Bypass Grafts One Month After Surgery. Ann Biomed Eng 2022; 50:1882-1894. [PMID: 35881267 DOI: 10.1007/s10439-022-03007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/02/2022] [Indexed: 12/30/2022]
Abstract
Although coronary artery bypass graft (CABG) surgery is a well-established intervention, graft failure can occur, and the underlying mechanisms remain incompletely understood. The purpose of this prospective study is to utilize computational fluid dynamics (CFD) to investigate how graft hemodynamics one month post surgery may vary among graft types, which have different long-term patency rates. Twenty-four grafts from 10 participants (64.6 ± 8.5 years, 9 men) were scanned with coronary CT angiography and 4D flow MRI one month after CABG surgery. Grafts included 10 left internal mammary arteries (LIMA), 3 radial arteries (RA), and 11 saphenous vein grafts (SVG). Image-guided CFD was used to quantify blood flow rate and wall area exposed to abnormal wall shear stress (WSS). Arterial grafts had a lower abnormal WSS area than venous grafts (17.9% vs. 70.1%; p = 0.001), and a similar trend was observed for LIMA vs. SVG (13.8% vs. 70.1%; p = 0.001). Abnormal WSS area correlated positively to lumen diameter (p < 0.001) and negatively to flow rate (p = 0.001). This CFD study is the first of its kind to prospectively reveal differences in abnormal WSS area 1 month post surgery among CABG types, suggesting that WSS may influence the differential long-term graft failure rates observed among these groups.
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Affiliation(s)
- Nhien Tran-Nguyen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | | | - Andrew Yan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen Fremes
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Piero Triverio
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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Anbazhakan S, Rios Coronado PE, Sy-Quia ANL, Seow LW, Hands AM, Zhao M, Dong ML, Pfaller MR, Amir ZA, Raftrey BC, Cook CK, D’Amato G, Fan X, Williams IM, Jha SK, Bernstein D, Nieman K, Pașca AM, Marsden AL, Horse KR. Blood flow modeling reveals improved collateral artery performance during the regenerative period in mammalian hearts. NATURE CARDIOVASCULAR RESEARCH 2022; 1:775-790. [PMID: 37305211 PMCID: PMC10256232 DOI: 10.1038/s44161-022-00114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/07/2022] [Indexed: 06/13/2023]
Abstract
Collateral arteries bridge opposing artery branches, forming a natural bypass that can deliver blood flow downstream of an occlusion. Inducing coronary collateral arteries could treat cardiac ischemia, but more knowledge on their developmental mechanisms and functional capabilities is required. Here we used whole-organ imaging and three-dimensional computational fluid dynamics modeling to define spatial architecture and predict blood flow through collaterals in neonate and adult mouse hearts. Neonate collaterals were more numerous, larger in diameter and more effective at restoring blood flow. Decreased blood flow restoration in adults arose because during postnatal growth coronary arteries expanded by adding branches rather than increasing diameters, altering pressure distributions. In humans, adult hearts with total coronary occlusions averaged 2 large collaterals, with predicted moderate function, while normal fetal hearts showed over 40 collaterals, likely too small to be functionally relevant. Thus, we quantify the functional impact of collateral arteries during heart regeneration and repair-a critical step toward realizing their therapeutic potential.
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Affiliation(s)
- Suhaas Anbazhakan
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- These authors contributed equally
| | - Pamela E. Rios Coronado
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- These authors contributed equally
| | | | - Lek Wei Seow
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Aubrey M. Hands
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Mingming Zhao
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Melody L. Dong
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Martin R. Pfaller
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
| | - Zhainib A. Amir
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Brian C. Raftrey
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | | | - Gaetano D’Amato
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Xiaochen Fan
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Ian M. Williams
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Sawan K. Jha
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Anca M. Pașca
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kristy Red Horse
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Howard Hughes Medical Institute, Stanford, CA, 94305, USA
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Patient-specific fluid–structure interaction simulation of the LAD-ITA bypass graft for moderate and severe stenosis: A doubt on the fractional flow reserve-based decision. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aranda-Michel E, Sultan I. Commentary: Cannot Escape the Stress of Precision Revascularization For Coronary Artery Disease. Semin Thorac Cardiovasc Surg 2021; 34:535-536. [PMID: 34004312 DOI: 10.1053/j.semtcvs.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh; Heart and Vascular Institute, University of Pittsburgh Medical Center.
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Belluschi I, Miceli A. Commentary: Coronary Surgery Goes Virtual! Semin Thorac Cardiovasc Surg 2021; 34:533-534. [PMID: 34000430 DOI: 10.1053/j.semtcvs.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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