Concomitant pulsatile and continuous flow VAD in biventricular and univentricular physiology: A comparison study with a numerical model

Arianna Di Molfetta, Gianfranco Ferrari, Roberta Iacobelli, Sergio Filippelli, Paolo Guccione, Libera Fresiello, Gianluigi Perri, Antonio Amodeo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: 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. Methods: 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) Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)74-81
Number of pages8
JournalInternational Journal of Artificial Organs
Volume40
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

Fingerprint

Pulsatile Flow
Pulsatile flow
Heart-Assist Devices
Physiology
Heart Ventricles
Numerical models
Hemodynamics
Pediatrics
Cardiac Output
Lung
Patient Simulation
Atrial Pressure
Arterial Pressure
Pressure

Keywords

  • BIVAD
  • Fontan
  • Lumped parameter model
  • Pediatrics

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Concomitant pulsatile and continuous flow VAD in biventricular and univentricular physiology : A comparison study with a numerical model. / Di Molfetta, Arianna; Ferrari, Gianfranco; Iacobelli, Roberta; Filippelli, Sergio; Guccione, Paolo; Fresiello, Libera; Perri, Gianluigi; Amodeo, Antonio.

In: International Journal of Artificial Organs, Vol. 40, No. 2, 01.02.2017, p. 74-81.

Research output: Contribution to journalArticle

@article{415a0a718c8b4f1e840ca5f18294bd12,
title = "Concomitant pulsatile and continuous flow VAD in biventricular and univentricular physiology: A comparison study with a numerical model",
abstract = "Introduction: 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. Methods: 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) Results: 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). Conclusions: 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.",
keywords = "BIVAD, Fontan, Lumped parameter model, Pediatrics",
author = "{Di Molfetta}, Arianna and Gianfranco Ferrari and Roberta Iacobelli and Sergio Filippelli and Paolo Guccione and Libera Fresiello and Gianluigi Perri and Antonio Amodeo",
year = "2017",
month = "2",
day = "1",
doi = "10.5301/ijao.5000562",
language = "English",
volume = "40",
pages = "74--81",
journal = "International Journal of Artificial Organs",
issn = "0391-3988",
publisher = "Wichtig Publishing",
number = "2",

}

TY - JOUR

T1 - Concomitant pulsatile and continuous flow VAD in biventricular and univentricular physiology

T2 - A comparison study with a numerical model

AU - Di Molfetta, Arianna

AU - Ferrari, Gianfranco

AU - Iacobelli, Roberta

AU - Filippelli, Sergio

AU - Guccione, Paolo

AU - Fresiello, Libera

AU - Perri, Gianluigi

AU - Amodeo, Antonio

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Introduction: 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. Methods: 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) Results: 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). Conclusions: 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.

AB - Introduction: 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. Methods: 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) Results: 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). Conclusions: 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.

KW - BIVAD

KW - Fontan

KW - Lumped parameter model

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=85015863246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015863246&partnerID=8YFLogxK

U2 - 10.5301/ijao.5000562

DO - 10.5301/ijao.5000562

M3 - Article

C2 - 28218352

AN - SCOPUS:85015863246

VL - 40

SP - 74

EP - 81

JO - International Journal of Artificial Organs

JF - International Journal of Artificial Organs

SN - 0391-3988

IS - 2

ER -