A computational analysis of different endograft designs for Zone 0 aortic arch repair.

OBJECTIVES: Aortic arch repair remains a major surgical challenge. Multiple manufacturers are developing branched endografts for Zone 0 endovascular repair, extending the armamentarium for minimally invasive treatment of aortic arch pathologies. We hypothesize that the design of the Zone 0 endograft has a significant impact on the postoperative haemodynamic performance, particularly in the cervical arteries. The goal of our study was to compare the postoperative haemodynamic performance of different Zone 0 endograft designs.

METHODS: Patient-specific, clinically validated, computational fluid dynamics simulations were performed in a 71-year-old woman with a 6.5-cm saccular aortic arch aneurysm. Additionally, 4 endovascular repair scenarios using different endograft designs were created. Haemodynamic performance was evaluated by calculation of postoperative changes in blood flow and platelet activation potential (PLAP) in the cervical arteries.

RESULTS: Preoperative cervical blood flow and mean PLAP were 1080 ml/min and 151.75, respectively. Cervical blood flow decreased and PLAP increased following endovascular repair in all scenarios. Endografts with 2 antegrade inner branches performed better compared to single-branch endografts. Scenario 3 performed the worst with a decrease in the total cervical blood flow of 4.8%, a decrease in the left hemisphere flow of 6.7% and an increase in the mean PLAP of 74.3%.

CONCLUSIONS: Endograft design has a significant impact on haemodynamic performance following Zone 0 endovascular repair, potentially affecting cerebral blood flow during follow-up. Our results demonstrate the use of computational modelling for virtual testing of therapeutic interventions and underline the need to monitor the long-term outcomes in this cohort of patients.