Di Molfetta Arianna, Amodeo Antonio, Fresiello Libera, Filippelli Sergio, Pilati Mara, Iacobelli Roberta, Adorisio Rachele, Colella Dionisio, Ferrari Gianfranco
Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
Institute of Clinical Physiology, CNR, Pisa, Italy.
J Artif Organs. 2016 Jun;19(2):105-13. doi: 10.1007/s10047-015-0874-5. Epub 2015 Nov 6.
The lack of an established experience on the use of VAD for the cavo-pulmonary assistance leads to the need of dedicated VADs development and animal experiments. A dedicated numerical model could support clinical and experimental strategies design and new VADs testing. The aim of this work is to perform a preliminary verification of a lumped parameter model of the cardiovascular system to simulate Fontan physiology and the effect of cavo-pulmonary assistance. Literature data of 4 pigs were used to simulate animals' baseline, and then the model was tested in simulating Fontan circulation and cavo-pulmonary-assisted condition comparing the simulation outcome (Sim) with measured literature data (Me). The results show that the numerical model can well reproduce experimental data in all three conditions (baseline, Fontan and assisted Fontan) [cardiac output (l/min): Me = 2.8 ± 1.7, Sim = 2.8 ± 1.8; ejection fraction (%): Me = 57 ± 17, Sim = 54 ± 17; arterial systemic pressure (mmHg): Me = 41.8 ± 18.6, Sim = 43.8 ± 18.1; pulmonary arterial pressure (mmHg): Me = 15.4 ± 8.9, Sim = 17.7 ± 9.9; caval pressure (mmHg): Me = 6.8 ± 4.1, Sim = 7 ± 4.6]. Systolic elastance, arterial systemic and arterial pulmonary resistances increase (10, 69, and 100 %) passing from the biventricular circulation to the Fontan physiology and then decrease (21, 39, and 50 %) once the VAD was implanted. The ventricular external work decreases (71 %) passing from the biventricular circulation to the Fontan physiology and it increases three times after the VAD implantation in parallel with the VAD power consumption. A numerical model could support clinicians in an innovative and challenging field as the use of VAD to assist the Fontan physiology and it could be helpful to personalize the VAD insertion on the base of ventricular systo-diastolic function, circulatory parameters and energetic variables.
由于缺乏使用心室辅助装置（VAD）进行腔肺循环辅助的既定经验，因此需要开发专用的VAD并开展动物实验。一个专用的数值模型可以支持临床和实验策略的设计以及新型VAD的测试。这项工作的目的是对心血管系统的集总参数模型进行初步验证，以模拟Fontan生理学以及腔肺循环辅助的效果。使用4头猪的文献数据来模拟动物的基线状态，然后在模拟Fontan循环和腔肺循环辅助状态下对模型进行测试，将模拟结果（Sim）与实测的文献数据（Me）进行比较。结果表明，该数值模型能够在所有三种状态（基线、Fontan和辅助Fontan）下很好地再现实验数据[心输出量（升/分钟）：Me = 2.8±1.7，Sim = 2.8±1.8；射血分数（%）：Me = 57±17，Sim = 54±17；动脉系统血压（毫米汞柱）：Me = 41.8±18.6，Sim = 43.8±18.1；肺动脉压（毫米汞柱）：Me = 15.4±8.9，Sim = 17.7±9.9；腔静脉压（毫米汞柱）：Me = 6.8±4.1，Sim = 7±4.6]。从双心室循环转变为Fontan生理状态时，收缩弹性、动脉系统阻力和肺动脉阻力增加（分别增加10%、69%和100%），而在植入VAD后则下降（分别下降21%、39%和50%）。从双心室循环转变为Fontan生理状态时，心室外部功降低（71%），而在植入VAD后，心室外部功增加了两倍，且与VAD的功耗平行。在使用VAD辅助Fontan生理这一创新且具有挑战性的领域中，数值模型可以为临床医生提供支持，并且有助于根据心室的收缩舒张功能、循环参数和能量变量来个性化VAD的植入。
