Impact of aortic grafts on arterial pressure: a computational fluid dynamics study.

OBJECTIVE Vascular prostheses currently used in vascular surgery do not have the same mechanical properties as human arteries. This computational study analyses the mechanisms by which grafts, placed in the ascending aorta (proximal) and descending aorta (distal), affect arterial blood pressure. METHODS A one-dimensional cardiovascular model was developed and adapted to include the graft geometry with in vitro measured mechanical properties. Pressure at the aortic root and haemodynamic parameters were computed and compared for a control, proximal and distal graft case. RESULTS In comparison to the control case, the proximal graft increased characteristic impedance by 58% versus only 1% change for the distal graft. The proximal and distal graft increased pulse pressure by 21% and 10%, respectively. CONCLUSIONS The mechanisms underlying pulse pressure increase are different for proximal and distal grafts. For the proximal graft, the primary reason for pulse pressure rise is augmentation of the forward wave, resulting from characteristic impedance increase. For the distal graft, the pulse pressure rise is associated with augmented wave reflections resulting from compliance mismatch. Overall, the proximal aortic graft resulted in greater haemodynamic alterations than the distal graft. Thus, it is likely that patients who receive ascending aorta grafts are more prone to systolic hypertension and therefore deserve closer blood pressure monitoring.