What is the clinical evidence from this study?

Study design: Other. Population: Coronary artery disease (n=1). Intervention: COMCAB computational model. Primary outcome: Predictive haemodynamic parameters of functional graft performance (MGF, PI, DF, BF).

September 27, 2022Open Access

A predictive patient-specific computational model of coronary artery bypass grafts for potential use by cardiac surgeons to guide selection of graft configurations

Q: What does this research mean for the field?

The novel patient-specific 1D-0D computational model, COMCAB, can predict hemodynamic parameters of functional graft performance to guide surgeons in selecting optimal coronary artery bypass graft configurations. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

A novel patient-specific 1D-0D computational model, COMCAB, was developed to predict hemodynamic parameters of functional graft performance to guide surgeons in selecting optimal coronary artery bypass graft configurations.

Structured PICO

Population

Patient-specific 1D-0D computational model based on CT coronary angiogram of 1 patient with severe triple vessel disease who underwent coronary artery bypass grafting.

Intervention

Patient-specific 1D-0D computational model ('COMCAB') simulating separate and composite total arterial grafting configurations.

Outcome

Predictive haemodynamic parameters of functional graft performance (mean graft flow, pulsatility index, diastolic filling, and percentage back flow).surrogate

A novel patient-specific 1D-0D computational model was developed to predict hemodynamic parameters of coronary artery bypass grafts, potentially aiding surgeons in selecting optimal graft configurations.

Limitations

Lack of a formal CT angiogram spanning the neck and abdomen required estimating typical radii and lengths of non-terminal systemic vessels from literature.
A simplified 3-element Windkessel model was used instead of a more sophisticated RCRCR model for the coronary microvasculature.

Abstract

Cardiac surgeons face a significant degree of uncertainty when deciding upon coronary artery bypass graft configurations for patients with coronary artery disease. This leads to significant variation in preferred configuration between different surgeons for a particular patient. Additionally, for the majority of cases, there is no consensus regarding the optimal grafting strategy. This situation results in the tendency for individual surgeons to opt for a "one size fits all" approach and use the same grafting configuration for the majority of their patients neglecting the patient-specific nature of the diseased coronary circulation. Quantitative metrics to assess the adequacy of coronary bypass graft flows have recently been advocated for routine intraoperative use by cardiac surgeons. In this work, a novel patient-specific 1D-0D computational model called "COMCAB" is developed to provide the predictive haemodynamic parameters of functional graft performance that can aid surgeons to avoid configurations with grafts that have poor flow and thus poor patency. This model has significant potential for future expanded applications.

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