Simulation of acute haemodynamic outcomes of the surgical strategies for the right ventricular failure treatment in pediatric LVAD

Arianna Di Molfetta, Gianfranco Ferrari, Roberta Iacobelli, Sergio Filippelli, Libera Fresiello, Maria G Gagliardi, Alessandro Toscano, Maria G Trivella, Antonio Amodeo

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Right ventricular failure (RVF) is one of the major complications during LVAD. Apart from drug therapy, the most reliable option is the implantation of RVAD. However, BIVAD have a poor prognosis and increased complications. Experiments have been conducted on alternative approaches, such as the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD and a cavo-pulmonary connection (CPC). This work aims at realizing a lumped parameter model (LPM) to compare the acute hemodynamic effects of ASD, CPC, CAS, RVAD in LVAD pediatric patients with RVF.

METHODS: Data of 5 pediatric patients undergoing LVAD were retrospectively collected to reproduce patients baseline hemodynamics with the LPM. The effects of continuous flow LVAD implantation complicated by RVF was simulated and then the effects of ASD, CPC, CAS and RVAD treatments were simulated for each patient.

RESULTS: The model successfully reproduced patients' baseline and the hemodynamic effects of the surgical strategies. Simulating the different surgical strategies, an unloading of the right ventricle and an increment of left ventricular preload were observed with an improvement of the hemodynamics (total cardiac output: ASD +15%, CPC +10%, CAS +70% RVAD +20%; right ventricular external work: ASD -19%, CPC -46%, CAS -76%, RVAD -32%; left ventricular external work: ASD +12%, CPC +28%, RVAD +64%).

CONCLUSIONS: The use of numerical model could offer an additional support for clinical decision-making, also potentially reducing animal experiments, to compare the outcome of different surgical strategies to treat RVF in LVAD.

Original languageEnglish
Pages (from-to)638-45
Number of pages8
JournalInternational Journal of Artificial Organs
Volume38
Issue number12
DOIs
Publication statusPublished - Feb 8 2016

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Pediatrics
Atrial Heart Septal Defects
Hemodynamics
Treatment Failure
Lung
Defects
Drug therapy
Patient Rights
Unloading
Cardiac Output
Heart Ventricles
Numerical models
Animals
Decision making
Experiments
Drug Therapy

Keywords

  • Cardiac Surgical Procedures
  • Child, Preschool
  • Computer Simulation
  • Decision Support Techniques
  • Female
  • Heart-Assist Devices
  • Hemodynamics
  • Humans
  • Infant
  • Male
  • Models, Cardiovascular
  • Numerical Analysis, Computer-Assisted
  • Patient Selection
  • Prosthesis Design
  • Recovery of Function
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Left
  • Ventricular Dysfunction, Right
  • Ventricular Function, Left
  • Ventricular Function, Right
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

Simulation of acute haemodynamic outcomes of the surgical strategies for the right ventricular failure treatment in pediatric LVAD. / Di Molfetta, Arianna; Ferrari, Gianfranco; Iacobelli, Roberta; Filippelli, Sergio; Fresiello, Libera; Gagliardi, Maria G; Toscano, Alessandro; Trivella, Maria G; Amodeo, Antonio.

In: International Journal of Artificial Organs, Vol. 38, No. 12, 08.02.2016, p. 638-45.

Research output: Contribution to journalArticle

Di Molfetta, Arianna ; Ferrari, Gianfranco ; Iacobelli, Roberta ; Filippelli, Sergio ; Fresiello, Libera ; Gagliardi, Maria G ; Toscano, Alessandro ; Trivella, Maria G ; Amodeo, Antonio. / Simulation of acute haemodynamic outcomes of the surgical strategies for the right ventricular failure treatment in pediatric LVAD. In: International Journal of Artificial Organs. 2016 ; Vol. 38, No. 12. pp. 638-45.
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abstract = "BACKGROUND: Right ventricular failure (RVF) is one of the major complications during LVAD. Apart from drug therapy, the most reliable option is the implantation of RVAD. However, BIVAD have a poor prognosis and increased complications. Experiments have been conducted on alternative approaches, such as the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD and a cavo-pulmonary connection (CPC). This work aims at realizing a lumped parameter model (LPM) to compare the acute hemodynamic effects of ASD, CPC, CAS, RVAD in LVAD pediatric patients with RVF.METHODS: Data of 5 pediatric patients undergoing LVAD were retrospectively collected to reproduce patients baseline hemodynamics with the LPM. The effects of continuous flow LVAD implantation complicated by RVF was simulated and then the effects of ASD, CPC, CAS and RVAD treatments were simulated for each patient.RESULTS: The model successfully reproduced patients' baseline and the hemodynamic effects of the surgical strategies. Simulating the different surgical strategies, an unloading of the right ventricle and an increment of left ventricular preload were observed with an improvement of the hemodynamics (total cardiac output: ASD +15{\%}, CPC +10{\%}, CAS +70{\%} RVAD +20{\%}; right ventricular external work: ASD -19{\%}, CPC -46{\%}, CAS -76{\%}, RVAD -32{\%}; left ventricular external work: ASD +12{\%}, CPC +28{\%}, RVAD +64{\%}).CONCLUSIONS: The use of numerical model could offer an additional support for clinical decision-making, also potentially reducing animal experiments, to compare the outcome of different surgical strategies to treat RVF in LVAD.",
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AU - Di Molfetta, Arianna

AU - Ferrari, Gianfranco

AU - Iacobelli, Roberta

AU - Filippelli, Sergio

AU - Fresiello, Libera

AU - Gagliardi, Maria G

AU - Toscano, Alessandro

AU - Trivella, Maria G

AU - Amodeo, Antonio

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N2 - BACKGROUND: Right ventricular failure (RVF) is one of the major complications during LVAD. Apart from drug therapy, the most reliable option is the implantation of RVAD. However, BIVAD have a poor prognosis and increased complications. Experiments have been conducted on alternative approaches, such as the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD and a cavo-pulmonary connection (CPC). This work aims at realizing a lumped parameter model (LPM) to compare the acute hemodynamic effects of ASD, CPC, CAS, RVAD in LVAD pediatric patients with RVF.METHODS: Data of 5 pediatric patients undergoing LVAD were retrospectively collected to reproduce patients baseline hemodynamics with the LPM. The effects of continuous flow LVAD implantation complicated by RVF was simulated and then the effects of ASD, CPC, CAS and RVAD treatments were simulated for each patient.RESULTS: The model successfully reproduced patients' baseline and the hemodynamic effects of the surgical strategies. Simulating the different surgical strategies, an unloading of the right ventricle and an increment of left ventricular preload were observed with an improvement of the hemodynamics (total cardiac output: ASD +15%, CPC +10%, CAS +70% RVAD +20%; right ventricular external work: ASD -19%, CPC -46%, CAS -76%, RVAD -32%; left ventricular external work: ASD +12%, CPC +28%, RVAD +64%).CONCLUSIONS: The use of numerical model could offer an additional support for clinical decision-making, also potentially reducing animal experiments, to compare the outcome of different surgical strategies to treat RVF in LVAD.

AB - BACKGROUND: Right ventricular failure (RVF) is one of the major complications during LVAD. Apart from drug therapy, the most reliable option is the implantation of RVAD. However, BIVAD have a poor prognosis and increased complications. Experiments have been conducted on alternative approaches, such as the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD and a cavo-pulmonary connection (CPC). This work aims at realizing a lumped parameter model (LPM) to compare the acute hemodynamic effects of ASD, CPC, CAS, RVAD in LVAD pediatric patients with RVF.METHODS: Data of 5 pediatric patients undergoing LVAD were retrospectively collected to reproduce patients baseline hemodynamics with the LPM. The effects of continuous flow LVAD implantation complicated by RVF was simulated and then the effects of ASD, CPC, CAS and RVAD treatments were simulated for each patient.RESULTS: The model successfully reproduced patients' baseline and the hemodynamic effects of the surgical strategies. Simulating the different surgical strategies, an unloading of the right ventricle and an increment of left ventricular preload were observed with an improvement of the hemodynamics (total cardiac output: ASD +15%, CPC +10%, CAS +70% RVAD +20%; right ventricular external work: ASD -19%, CPC -46%, CAS -76%, RVAD -32%; left ventricular external work: ASD +12%, CPC +28%, RVAD +64%).CONCLUSIONS: The use of numerical model could offer an additional support for clinical decision-making, also potentially reducing animal experiments, to compare the outcome of different surgical strategies to treat RVF in LVAD.

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KW - Time Factors

KW - Treatment Outcome

KW - Ventricular Dysfunction, Left

KW - Ventricular Dysfunction, Right

KW - Ventricular Function, Left

KW - Ventricular Function, Right

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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