Di Molfetta Arianna, Ferrari Gianfranco, Iacobelli Roberta, Filippelli Sergio, Fresiello Libera, Guccione Paolo, Toscano Alessandra, Amodeo Antonio
Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù.
Cardiovascular Engineering, Institute of Clinical Physiology, Rome, Italy.
Artif Organs. 2017 Mar;41(3):242-252. doi: 10.1111/aor.12911.
The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the simultaneous use of pulsatile (P) and continuous flow (C) ventricular assist devices (VADs) on the same patient. Echocardiographic and hemodynamic data of five pediatric patients undergoing VAD implantation were retrospectively collected and used to simulate the patients' baseline condition with the numerical model. Once the baseline hemodynamic was reproduced for each patient, the following assistance modalities were simulated: (a) CVAD assisting the right ventricle and PVAD assisting the left ventricle (RCF + LPF), (b) CVAD assisting the left ventricle and PVAD assisting the right ventricle (LCF + RPF). The numerical model can well reproduce patients' baseline. The cardiac output increases in both assisted configurations (RCF + LPF: +17%, LCF + RPF: +21%, P = ns), left (right) ventricular volumes decrease more evidently in the configuration LCF + RPF (RCF + LPF), left (right) atrial pressure decreases in the LCF + RPF (RCF + LPF) modality. The pulmonary arterial pressure slightly decreases in the configuration LCF + RPF and it increases with RCF + LPF. Left and right ventricular external work increases in both configurations probably because of the total cardiac output increment. However, left and right artero-ventricular coupling improves especially in the LCF + RPF (-36% for the left ventricle and -21% for the right ventricle, P = ns). The pulsatility index decreases by 8.5% in the configuration LCF + RPF and increases by 6.4% with RCF + LPF (P = 0.0001). A numerical model could be useful to tailor on patients the choice of the VAD that could be implanted to improve the hemodynamic benefits. Moreover, a model could permit to simulate extreme physiological conditions and innovative configurations, as the implantation of both CVAD and PVAD on the same patient.
这项工作的目的是开发并测试一个心血管系统的集总参数模型，以模拟在同一患者身上同时使用搏动性（P）和连续流（C）心室辅助装置（VAD）的情况。回顾性收集了五名接受VAD植入的儿科患者的超声心动图和血流动力学数据，并用于通过数值模型模拟患者的基线状况。一旦为每位患者重现了基线血流动力学，便模拟了以下辅助模式：（a）CVAD辅助右心室，PVAD辅助左心室（RCF + LPF），（b）CVAD辅助左心室，PVAD辅助右心室（LCF + RPF）。数值模型能够很好地重现患者的基线情况。在两种辅助配置下心输出量均增加（RCF + LPF：增加17%，LCF + RPF：增加21%，P = 无显著差异），在LCF + RPF配置下左（右）心室容积下降更明显（RCF + LPF），在LCF + RPF（RCF + LPF）模式下左（右）心房压力下降。在LCF + RPF配置下肺动脉压力略有下降，而在RCF + LPF配置下则升高。在两种配置下左、右心室的外部功均增加，这可能是由于总心输出量增加所致。然而，左、右房室耦合尤其在LCF + RPF配置下得到改善（左心室为-36%，右心室为-21%，P = 无显著差异）。在LCF + RPF配置下搏动指数下降8.5%，在RCF + LPF配置下增加6.4%（P = 0.0001）。数值模型对于根据患者情况定制可植入的VAD选择以提高血流动力学益处可能是有用的。此外，一个模型可以允许模拟极端生理状况和创新配置，例如在同一患者身上同时植入CVAD和PVAD。
