Stanford A型主动脉夹层术后再干预的血流动力学分析

Hemodynamic analysis of postoperative reintervention for Stanford type A aortic dissection

目的基于计算流体力学(computational fluid dynamics,CFD)方法,构建残余假腔风险预测模型,计算流体力学参数,评估Stanford A型主动脉夹层首次手术后的恢复效果,实现远期再干预的预警和转归预测。方法纳入2015年1月1日至2021年5月30日在中国医学科学院阜外医院血管中心就诊的Stanford A型主动脉夹层患者,获取首次手术后早期复查CTA影像资料,利用计算流体力学原理进行降主动脉血管的流体力学参数计算,对比预后不同的两组间各参数的差异,探索假腔进展、再干预的危险因素。结果共纳入24例患者,年龄(47.88±9.84)岁(30~64岁),男21例(87.5%,21/24)。根据远期预后和有无接受远端血管干预,以降主动脉直径进行匹配,分为对照组和胸腹组,各12例。血流动力学分析显示,胸腹组假腔血流量显著增多,以湍流、涡流为主,降主动脉近段可见多个真假腔交通。胸腹组降主动脉真假腔压力平衡点距离左锁骨下动脉开口处更近[(22.00±3.91)cm对(36.00±1.77)cm,P<0.001],且假腔压力大于真腔压力。结论计算流体力学方法可以基于CTA利用数学模型简化并可视化复杂的人体血流和术后结构,真假腔压力平衡点近移和假腔压力大是反映真假腔交通、假腔重塑差、面临二次手术干预的危险因素。

Objective A residual false lumen progress risk prediction model was constructed based on computational fluid dynamics and biomechanical parameters were calculated to assess the factors affecting the long-term reintervention after the first operation.Methods Patients with Stanford type A aortic dissection admitted to Fuwai hospital were retrospectively collected and divided into control group and thoracoabdominal aortic replacement group according to long-term prognosis or history of reintervention.The fluid parameters of the descending aorta were calculated based on the early CTA imaging data after first operation.The differences of parameters between the two groups were compared to explore the risk factors.Results A total of 24 patients were included from January 2015 to May 2021.The average age was(47.88±9.84)years old,21(87.5%)male,and 3 female.The balance position of luminal pressure difference in the descending aorta was closer to the opening of the left subclavicular artery[(22.00±3.91)cm vs.(36.00±1.77)cm,P<0.001],and the false lumen pressure was greater than the true lumen pressure in the thoracoabdominal aortic replacement group.Conclusion The computational fluid dynamics method can simplify and visualize the complex human blood flow and postoperative structure based on the mathematical model.The lumen pressure balance point moving to the proximal are the risk factors for poor remodeling of the descending aorta and reintervention.