Fluid mechanics in aortic prostheses after a Bentall procedure

The simultaneous replacement of a diseased aortic valve, aortic root and ascending aorta with a composite graft equipped with a prosthetic valve is a nowadays standard surgical approach, known as the Bentall procedure: the Valsalva sinuses of the aortic root are sacrificed and the coronary arteries are reconnected directly to the graft. In practice, two different composite-material prostheses are largely used by surgeons: a standard straight graft and the Valsalva graft with a bulged portion that better reproduces the aortic root anatomy. The aim of the present investigation is to study the effect of the graft geometry on the the flowfield as well as on the stress concentration at the level of coronary-root anastomoses during the cardiac cycle. An accurate three-dimensional numerical method, based on the immersed boundary technique, is proposed to study the flow inside moving and deformable geometries. Direct numerical simulations of the flow inside the two prostheses, equipped with a bileaflet mechanical valve with curved leaflets, under physiological pulsatile inflow conditions show that, when using the Valsalva graft, the stress level near the coronary-root anastomoses is about half that obtained using the standard straight graft.