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[Preprint]. 2025 Aug 22:rs.3.rs-7320100.
doi: 10.21203/rs.3.rs-7320100/v1.

Virtual Coronary Artery Bypass Grafting

Wei Wu  1 , Priyansh Patel  1 , Parth Vikram Singh  1 , Shijia Zhao  1 , Yash Vardhan Trivedi  1 , Rahul Chikatimalla  1 , Abdulkader Shaar  1 , Sree Sindhu Vijayarao  1 , Varsha Miriyala  1 , Muhammad Fiyaz Alam  1 , Parth Munjal  1 , Rakshita Ramesh Bhat  1 , Kanishka Goswami  1 , Changkye Lee  1 , Ioanna Chatzizisi  1 , Emmanouil S Brilakis  2 , George Dangas  3 , Shahbaz Malik  4 , Aleem Siddique  4 , Yiannis Chatzizisis  1
Affiliations

Virtual Coronary Artery Bypass Grafting

Wei Wu et al. Res Sq. .

Abstract

Coronary artery bypass grafting (CABG) offers superior long-term survival over percutaneous coronary intervention (PCI) or medical therapy in patients with complex coronary artery disease (CAD). This prospective proof-of-concept study aims to develop and validate a non-invasive computational platform that integrates coronary computed tomographic angiography (CCTA) and computational fluid dynamics (CFD) to predict post-CABG hemodynamics, including virtual grafting and fractional flow reserve (FFR) estimation. Four patients with stable multi-vessel CAD undergoing elective CABG were included. Pre-CABG CCTA was used for 3D reconstruction of coronary anatomy. Virtual bypass grafting was performed using both patient-specific graft sizes, derived from post-operative imaging and mixed-specificity graft sizes using patient-specific LIMA and standardized non-LIMA graft sizes, derived from population averages. CFD simulations were used to estimate post-CABG FFR and validated against invasive FFR measurements. Computational FFR showed strong correlation with invasive FFR (patient-specific: r2 = 0.92; mixed-specificity: r2 = 0.88). Bland-Altman analysis demonstrated minimal bias (patient-specific: 0.006 ± 0.027; mixed-specificity: -0.007 ± 0.029). Agreement with invasive FFR was 90% for patient-specific grafts (κ = 0.74, p = 0.016) and 80% for mixed-specificity grafts (κ = 0.41, p = 0.107). This virtual CABG model represents a significant advancement over existing non-invasive systems by accurately predicting post-operative hemodynamics and FFR, offering potential to optimize graft strategies and reduce reliance on invasive FFR. Future studies should explore clinical integration and large-scale validation to enhance CABG surgical planning and improve patient outcomes.

Keywords: Computational Fluid Dynamics; Coronary Artery Bypass Grafting; Fractional Flow Reserve; Virtual Grafting.

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Conflict of interest statement

Yiannis S. Chatzizisis: Speaker honoraria, advisory board fees, and research grant from Boston Scientific Inc.; Advisory board fees and research grant from Medtronic Inc.; Issued U.S. patent (No. 11,026,749) and international patent pending (application No. PCT/US2020/057304) for the invention entitled “Computational simulation platform for the planning of interventional procedures”; Co-founder of ComKardia Inc.

Figures

Figure 1
Figure 1
Virtual CABG platform for 3D reconstruction Illustrates the workflow for the study design; CABG: Coronary artery bypass grafting; CFD: Computational fluid dynamics
Figure 2
Figure 2
3D reconstructed stenosis in the native model Shows the pre-CABG 3D-reconstructed stenoses for all arteries; RCA: Right coronary artery; LAD: Left anterior descending artery; LCX: Left circumflex artery
Figure 3
Figure 3
Anatomical comparison of patient specific and mixed-specificity 3D reconstruction Provides an anatomical comparison of 3D reconstruction between the patient-specific and mixed-specificity graft sizes for all cases; RCA: Right coronary artery; LAD: Left anterior descending artery; LCX: Left circumflex artery; rPDA: Right posterior descending artery; D1: Diagonal artery; SVG: Saphenous venous graft; LIMA: Left internal mammary artery
Figure 4
Figure 4
Comparative CFD analysis between patient specific and mixed-specificity graft 3D reconstruction Shows comparison between invasive FFR and computational FFR; RCA: Right coronary artery; LAD: Left anterior descending artery; LCX: Left circumflex artery; rPDA: Right posterior descending artery; D1: Diagonal artery; OM: Obtuse marginal; SVG: Saphenous venous graft; LIMA: Left internal mammary artery
Figure 5
Figure 5
Simple linear regression curves between invasive and computational FFR Illustrates simple linear regression curves between invasive and computational FFR; FFR: Fractional flow reserve
Figure 6
Figure 6
BA analysis of difference versus average between invasive and computational FFR. Illustrates BA analysis plots between invasive and computational FFR; FFR: Fractional flow reserve
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