Surgical strategy for aortic arch reconstruction after the Norwood procedure based on numerical flow analysis

Shohei Miyazaki; Kagami Miyaji; Keiichi Itatani; Norihiko Oka; Shinji Goto; Masanori Nakamura; Tadashi Kitamura; Tetsuya Horai; Koichi Sughimoto; Yuki Nakamura; Naoki Yoshimura

doi:10.1093/icvts/ivx332

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Surgical strategy for aortic arch reconstruction after the Norwood procedure based on numerical flow analysis

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Surgical strategy for aortic arch reconstruction after the Norwood procedure based on numerical flow analysis

Shohei Miyazaki, Kagami Miyaji, Keiichi Itatani, Norihiko Oka, Shinji Goto, Masanori Nakamura, Tadashi Kitamura, Tetsuya Horai, Koichi Sughimoto, Yuki Nakamura, …

Interactive cardiovascular and thoracic surgery, Vol.26(3), pp.460-467

03/01/2018

DOI: 10.1093/icvts/ivx332

PMID: 29049796

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Abstract

OBJECTIVES: Inefficient aortic flow after the Norwood procedure is known to lead to the deterioration of ventricular function due to an increased cardiac workload. To prevent the progression of aortic arch obstruction, arch reconstruction concomitant with second-stage surgery is recommended. The aim of this study was to determine the indications for reconstruction based on numerical simulation and to reveal the morphology that affects the haemodynamic parameters. METHODS: Fifteen patients who underwent the Norwood procedure or arch repair and Damus-Kaye-Stansel anastomosis were enrolled. The pressure gradient in aortic arch was 1.6 +/- 3.9 mmHg (ranged from 0 to 12 mmHg) on catheter examination. Six patients who had prominent turbulent flow accompanied with a large flow energy loss index greater than 40 mW/m(2) and high wall shear stress greater than 100 Pa underwent arch reconstruction. RESULTS: After arch reconstruction, the energy loss index significantly decreased from 88.5 +/- 50.0 mW/m(2) to 23.1 +/- 10.4 mW/m(2) (P = 0.026) and wall shear stress significantly decreased from 194.5 +/- 87.4 Pa to 60.3 +/- 40.5 Pa (P = 0.0062). There were 3 late deaths due to heart failure caused by progressive atrioventricular valve regurgitation during the follow-up period (60 months). The systemic ventricular function was preserved in the remaining patients without any pressure gradients in the arch. CONCLUSIONS: Determining the surgical strategy for arch reconstruction based on numerical flow analysis may effectively reduce the ventricular load even if no stenosis or pressure gradients are observed on catheter examination or echocardiography.

Respiratory System

Surgery

Cardiac & Cardiovascular Systems

Cardiovascular System & Cardiology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Surgical strategy for aortic arch reconstruction after the Norwood procedure based on numerical flow analysis
Creators: Shohei Miyazaki - Kitasato University
Kagami Miyaji - Kitasato University
Keiichi Itatani - Kyoto Prefectural University of Medicine
Norihiko Oka - Kitasato University
Shinji Goto - Saitama University
Masanori Nakamura - Nagoya Institute of Technology
Tadashi Kitamura - Kitasato University
Tetsuya Horai - Kitasato University
Koichi Sughimoto - Kitasato University
Yuki Nakamura - Kitasato University
Naoki Yoshimura - University of Toyama
Resource Type: Journal article
Publication Details: Interactive cardiovascular and thoracic surgery, Vol.26(3), pp.460-467
DOI: 10.1093/icvts/ivx332
PMID: 29049796
NLM abbreviation: Interact Cardiovasc Thorac Surg
ISSN: 1569-9293
eISSN: 1569-9285
Publisher: Oxford Univ Press
Number of pages: 8
Grant note: Medtronic Japan (Tokyo, Japan) Hitachi Aloka Medical (Tokyo, Japan) 15K09095 / Grants-in-Aid for Scientific Research; Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT); Japan Society for the Promotion of Science; Grants-in-Aid for Scientific Research (KAKENHI)
Language: English
Date published: 03/01/2018
Academic Unit: Cardiothoracic Surgery
Record Identifier: 9985164231102771

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