Di Molfetta Arianna, Ferrari Gianfranco, Iacobelli Roberta, Filippelli Sergio, Guccione Paolo, Fresiello Libera, Perri Gianluigi, Amodeo Antonio
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome - Italy.
Institute of Clinical Physiology, National Research Center, Rome - Italy.
Int J Artif Organs. 2017 Mar 16;40(2):74-81. doi: 10.5301/ijao.5000562. Epub 2017 Feb 11.
To develop and test a lumped parameter model to simulate and compare the effects of the simultaneous use of continuous flow (CF) and pulsatile flow (PF) ventricular assist devices (VADs) to assist biventricular circulation vs. single ventricle circulation in pediatrics.
Baseline data of 5 patients with biventricular circulation eligible for LVAD and of 5 patients with Fontan physiology were retrospectively collected and used to simulate patient baselines. Then, for each patient the following simulations were performed: (a) CF VAD to assist the left ventricle (single ventricle) + a PF VAD to assist the right ventricle (cavo-pulmonary connection) (LCF + RPF); (b) PF VAD to assist the left ventricle (single ventricle) + a CF VAD to assist the right ventricle (cavo-pulmonary connection) (RCF + LPF).
In biventricular circulation, the following results were found: cardiac output (17% RCF + LPF, 21% LCF + RPF), artero-ventricular coupling (-36% for the left ventricle and -21.6% for the right ventricle), pulsatility index (+6.4% RCF + LPF, p = 0.02; -8.5% LCF + RPF, p = 0.00009). Right (left) atrial pressure and right (left) ventricular volumes are decreased by the RCF + LPF (by RPF + LCF). Pulmonary arterial pressure decreases in the LCF + RPF configuration. In Fontan physiology: cardiac output (LCF + RPF 35% vs. 8% in RCF + LPF), ventricular preload (+4% RCF + LPF, -10% LCF + RPF), Fontan conduit pressure (-5% RCF + LPF, +7% LCF + RPF), artero-ventricular coupling (-14% RCF + LPF vs. -41% LCF + RPF) and pulsatility (+13% RCF + LPF, - 8% LCF + RPF).
A numerical model supports clinicians in defining and innovating the VAD implantation strategy to maximize the hemodynamic benefits. Results suggest that the hemodynamic benefits are maximized by the LCF + RPF configuration.
开发并测试一种集总参数模型，以模拟和比较同时使用连续流（CF）和搏动流（PF）心室辅助装置（VAD）辅助小儿双心室循环与单心室循环的效果。
回顾性收集5例适合左心室辅助装置的双心室循环患者和5例Fontan循环患者的基线数据，并用于模拟患者基线。然后，对每位患者进行以下模拟：（a）CF VAD辅助左心室（单心室）+ PF VAD辅助右心室（腔肺连接）（LCF + RPF）；（b）PF VAD辅助左心室（单心室）+ CF VAD辅助右心室（腔肺连接）（RCF + LPF）。
在双心室循环中，发现以下结果：心输出量（RCF + LPF为17%，LCF + RPF为21%），动静脉耦合（左心室为-36%，右心室为-21.6%），搏动指数（RCF + LPF为+6.4%，p = 0.02；LCF + RPF为-8.5%，p = 0.00009）。RCF + LPF可降低右（左）心房压力和右（左）心室容积（RPF + LCF可降低左（右）心房压力和左（右）心室容积）。在LCF + RPF配置中，肺动脉压力降低。在Fontan循环中：心输出量（LCF + RPF为35%，RCF + LPF为8%），心室前负荷（RCF + LPF为+4%，LCF + RPF为-10%），Fontan导管压力（RCF + LPF为-5%，LCF + RPF为+7%），动静脉耦合（RCF + LPF为-14%，LCF + RPF为-41%）和搏动性（RCF + LPF为+13%，LCF + RPF为-8%）。
一个数值模型可支持临床医生定义和创新VAD植入策略，以最大化血流动力学益处。结果表明，LCF + RPF配置可使血流动力学益处最大化。
