Brüning Jan, Yevtushenko Pavlo, Schlief Adriano, Jochum Tobias, van Gijzen Livia, Meine Sonja, Romberg Jan, Kuehne Titus, Arndt Andreas, Goubergrits Leonid
Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Berlin, Germany.
Front Cardiovasc Med. 2023 Sep 7;10:1193209. doi: 10.3389/fcvm.2023.1193209. eCollection 2023.
To assess whether in-silico models can be used to predict the risk of thrombus formation in pulmonary artery pressure sensors (PAPS), a chronic animal study using pigs was conducted. Computed tomography (CT) data was acquired before and immediately after implantation, as well as one and three months after the implantation. Devices were implanted into 10 pigs, each one in the left and right pulmonary artery (PA), to reduce the required number of animal experiments. The implantation procedure aimed at facilitating optimal and non-optimal positioning of the devices to increase chances of thrombus formation. Eight devices were positioned non-optimally. Three devices were positioned in the main PA instead of the left and right PA. Pre-interventional PA geometries were reconstructed from the respective CT images, and the devices were virtually implanted at the exact sites and orientations indicated by the follow-up CT after one month. Transient intra-arterial hemodynamics were calculated using computational fluid dynamics. Volume flow rates were modelled specifically matching the animals body weights. Wall shear stresses (WSS) and oscillatory shear indices (OSI) before and after device implantation were compared. Simulations revealed no relevant changes in any investigated hemodynamic parameters due to device implantation. Even in cases, where devices were implanted in a non-optimal manner, no marked differences in hemodynamic parameters compared to devices implanted in an optimal position were found. Before implantation time and surface-averaged WSS was Pa, whereas OSI was , respectively. Areas affected by low WSS magnitudes were cm, whereas the areas affected by high OSI were cm. After device implantation, WSS and OSI were Pa and , respectively. Surface areas affected by low WSS and high OSI were cm, and cm, respectively. This in-silico study indicates that no clinically relevant differences in intra-arterial hemodynamics are occurring after device implantation, even at non-optimal positioning of the sensor. Simultaneously, no embolic events were observed, suggesting that the risk for thrombus formation after device implantation is low and independent of the sensor position.
为评估计算机模拟模型是否可用于预测肺动脉压力传感器(PAPS)中血栓形成的风险,开展了一项使用猪的慢性动物研究。在植入前、植入后即刻以及植入后1个月和3个月采集计算机断层扫描(CT)数据。将装置植入10头猪体内,每个装置分别植入左、右肺动脉(PA),以减少所需的动物实验数量。植入程序旨在促进装置的最佳和非最佳定位,以增加血栓形成的几率。8个装置定位不佳。3个装置植入主肺动脉而非左、右肺动脉。从各自的CT图像重建介入前的肺动脉几何形状,并将装置虚拟植入1个月后随访CT所示的确切位置和方向。使用计算流体动力学计算瞬时动脉内血流动力学。对体积流率进行建模,使其与动物体重具体匹配。比较装置植入前后的壁面剪应力(WSS)和振荡剪应力指数(OSI)。模拟显示,由于装置植入,任何研究的血流动力学参数均无相关变化。即使在装置以非最佳方式植入的情况下,与以最佳位置植入的装置相比,血流动力学参数也未发现明显差异。植入前,时间和表面平均WSS为 帕斯卡,而OSI分别为 。受低WSS幅度影响的面积为 平方厘米,而受高OSI影响的面积为 平方厘米。装置植入后,WSS和OSI分别为 帕斯卡和 。受低WSS和高OSI影响的表面积分别为 平方厘米和 平方厘米。这项计算机模拟研究表明,即使传感器定位不佳,装置植入后动脉内血流动力学也不会出现临床相关差异。同时,未观察到栓塞事件,这表明装置植入后血栓形成的风险较低且与传感器位置无关。