Yıldırım Canberk, Ural Berk, Odemis Ender, Donmazov Samir, Pekkan Kerem
Department of Mechanical Engineering, Istanbul Bilgi University, Istanbul, 34060, Turkey.
Department of Mechanical Engineering, Koc University, Rumeli Feneri Campus, Sarıyer, Istanbul, 34450, Turkey.
Cardiovasc Eng Technol. 2025 Apr;16(2):222-237. doi: 10.1007/s13239-024-00769-4. Epub 2024 Dec 20.
Pulmonary atresia with intact ventricular septum is a multifactorial disease requiring complex surgeries. The treatment route is determined based on the right ventricle (RV) size, tricuspid annulus size and coronary circulation dependency of RV. Since multiple parameters influence the post-operative success, a personalized decision-making based on computed hemodynamics is hypothesized to improve the treatment efficacy.
A lumped parameter cardiovascular model is developed to calculate the hemodynamics of virtual patients which are generated by statistical distribution of circulation parameters. Four cohorts each with 30 digital patients are grouped based on RV size. For each patient, biventricular and one-and-half ventricle (1.5 V) repair were applied in silico and assessed via pressure, flow and saturations computed for every organ bed.
Biventricular and 1.5 V repair yield significant increase in the pulmonary flow and oxygen saturation for all patients compared to the pre-operative state (p-values < 0.001). Approximately 30% of generated patients failed to meet the sufficient saturation and flow following biventricular repair and were directed to 1.5 V repair. However, 14% of these 1.5 V repair patients failed post-operatively, requiring Fontan completion. Based on the pre-determined hemodynamics criteria, this study implies that patients having RV sizes larger than 22 ml/m are likely to undergo successful biventricular repair.
Pending further clinical trials, computational pre-interventional planning has the potential to screen patients that would not optimally fit to the traditional pathway prior to in vivo execution by providing personalized hemodynamic outcome. Statistical approach allows in silico clinical trials, useful for diseases with low patient numbers.
室间隔完整的肺动脉闭锁是一种需要进行复杂手术的多因素疾病。治疗方案是根据右心室（RV）大小、三尖瓣环大小以及RV对冠状动脉循环的依赖性来确定的。由于多个参数会影响术后成功率，因此推测基于计算血流动力学的个性化决策制定可提高治疗效果。
开发了一种集总参数心血管模型，以计算由循环参数的统计分布生成的虚拟患者的血流动力学。根据RV大小将四个队列，每个队列30名数字患者进行分组。对于每名患者，在计算机上应用双心室和单心室加半心室（1.5V）修复，并通过计算每个器官床的压力、流量和饱和度进行评估。
与术前状态相比，双心室和1.5V修复使所有患者的肺血流量和氧饱和度显著增加（p值<0.001）。大约30%的生成患者在双心室修复后未能达到足够的饱和度和流量，因此转向1.5V修复。然而，这些1.5V修复患者中有14%术后失败，需要完成Fontan手术。根据预先确定的血流动力学标准，本研究表明，RV大小大于22 ml/m的患者可能双心室修复成功。
在进一步的临床试验之前，计算机预干预规划有可能通过提供个性化的血流动力学结果，筛选出不太适合传统治疗途径的患者。统计方法允许进行计算机模拟临床试验，这对于患者数量较少的疾病很有用。
