Fluid-structure interaction simulation of visceral perfusion and impact of different cannulation methods on aortic dissection

Abstract Hemodynamics in aortic dissection (AD) is closely associated with the risk of aortic aneurysm, coarctation, rupture, hypertension, and malperfusion. Altered blood flow in patients with AD can lead to severe complications such as visceral malperfusion. In this study, we aimed to investigate the effect of cannulation flow on hemodynamics in patients with AD using a fluid-structure interaction simulation. We developed a specific-idealized AD model including intimal tear on descending thoracic aorta. Two different cannulation methods were tested: 1) Axillary cannulation (AC) only through the brachiocephalic trunk, and 2) combined axillary and femoral cannulation (AFC) through the brachiocephalic trunk and the right common iliac artery. The AC was found to develop the pressure difference between the true and false lumens due to the difference of the flow rate through each lumen. This pressure difference collapses the true lumen, disturbing blood flow to the celiac and superior mesenteric arteries. However, in the AFC, the pressure levels between the two lumens were similar, no collapse occurred, and the visceral flow was increased compared to that in the AC. Lastly, the collapse of true lumen was affected by the cannulation flow rate and also stiffness of the intimal flap.