基于血流动力学的冠状动脉搭桥移植管通透性研究

The critical complication of coronary artery bypass grafting(CABG) is the graft failure which is caused by progression of atherosclerosis and intimal hyperplasia in the distal anastomosis and graft itself, resulting in low long-term graft patency. Graft failure severly increases the risk of myocardial infarction and re-operation. It is of great scientific importance to CABG surgical decision making and of potential to clinical application to understand the hemodynamic mechanism of graft failure and to improve the graft patency. This project aims at enhancing the graft patency by optimizing hemodynamics of revascularisation for CABG. Firstly, the fractional flow reserve(FFR) which is a functional indicator of coronary artery will be numerically calculated based on the lumped parameter model of cardiovascular system, and it will be combined with the SYNTAX anatomical assessment of coroanry artery stenosis severity to develope a hemodynamic-based predictive model for graft patency. Secondly, the geometrical multiscale modeling and in vitro experimental method will be utilized to study the local hemodynamics in the interested 3D revascularisation regions, searching for an optimized surgical strategy for high long-term graft patency rates. Finally, a coronary artery bypass grafting surgical planning software will be developed for surgical decision making assistant in clinic on the basis of hemodynamics optimization.

冠状动脉搭桥术最主要的并发症是移植管失效，即搭桥吻合口或移植管本身形成粥样硬化斑块和内膜增生，使移植管的通透性不良，严重增加患者心肌梗死的危险，导致重复手术。研究冠状动脉搭桥移植管失效的血流动力学机理，预测并保持移植管的通透性，对提高冠状动脉搭桥术的科学化决策水平具有科学意义和潜在的临床应用价值。本项目将通过血流动力学优化设计，避免移植管失效的危险性血流动力学来提高冠状动脉搭桥移植管的通透性。拟采用个性化的心血管系统集中参数模型，数值计算冠状动脉血流储备分数，并将这一冠状动脉功能学评价指标与冠状动脉解剖学评价的SYNTAX评分相结合，建立基于血流动力学的移植管通透性预测模型；在此基础上，采用几何多尺度数值模拟和体外模型实验的方法，研究手术局部的三维血流动力学，以移植管通透性为目标来寻求优化的搭桥方案。最后，开发基于血流动力学优化的冠状动脉搭桥手术规划软件，为临床手术决策服务。

冠状动脉搭桥术最主要的并发症是搭桥移植管通透性不良。研究冠状动脉搭桥移植管失效的血流动力学机理，预测并保持移植管的通透性，对提高冠状动脉搭桥术的临床决策水平具有重要的理论意义和潜在的临床应用价值。本项目基于冠脉搭桥手术移植管血流动力学的分析与优化设计，通过避免移植管失效的危险性血流动力学来提高冠脉搭桥移植管的通透性。1. 建立了冠状动脉解剖学病变程度评价指标SYNTAX的自动评分方法和功能学病变程度评价指标血流储备分数FFR的无创数值计算方法，实现了冠状动脉搭桥术适应证的解剖学和功能学快速综合评价; 2. 实现了基于血流动力学优化的冠状动脉搭桥手术规划。采用几何多尺度数值模拟的方法研究移植管的血流动力学，以移植管通透性为目标来优化搭桥方案的血流动力学; 3. 基于临床移植管通透性的回顾性和前瞻性研究，建立了基于个性化血流动力学评价的移植管通透性预测方法；4. 建立了冠状动脉搭桥术血流动力学体外模型PIV实验系统，研究了竞争流对搭桥移植管血流动力学及通透性的影响。5. 开发了基于血流动力学优化的冠状动脉搭桥手术规划软件，为临床手术提供了快速有效的辅助决策工具。