Use of Ventricular Assist Device in Univentricular Physiology

The Role of Lumped Parameter Models

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

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Failing single-ventricle (SV) patients might benefit from ventricular assist devices (VADs) as a bridge to heart transplantation. Considering the complex physiopathology of SV patients and the lack of established experience, the aim of this work was to realize and test a lumped parameter model of the cardiovascular system, able to simulate SV hemodynamics and VAD implantation effects. Data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Additionally, both the effects of ventricular assistance and cavopulmonary assistance were simulated in different pathologic conditions on Fontan patients, including systolic dysfunction, diastolic dysfunction, and pulmonary vascular resistance increment. The model can reproduce patients' baseline well. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output (CO) in all the three palliation conditions (Norwood 77.2%, Glenn 38.6%, and Fontan 17.2%); (ii) decreases the SV external work (SVEW) (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) increases the mean pulmonary arterial pressure (Pap) (Norwood 39.7%, Glenn 12.1%, and Fontan 3%). In Fontan circulation, with systolic dysfunction, the left VAD (LVAD) increases CO (35%), while the right VAD (RVAD) determines a decrement of inferior vena cava pressure (Pvci) (39%) with 34% increment of CO. With diastolic dysfunction, the LVAD increases CO (42%) and the RVAD decreases the Pvci. With pulmonary vascular resistance increment, the RVAD allows the highest CO (50%) increment with the highest decrement of Pvci (53%). The single ventricular external work (SVEW) increases (decreases) increasing the VAD speed in cavopulmonary (ventricular) assistance. Numeric models could be helpful in this challenging and innovative field to support patients and VAD selection to optimize the clinical outcome and personalize the therapy.

Original languageEnglish
JournalArtificial Organs
DOIs
Publication statusAccepted/In press - 2015

Fingerprint

Heart-Assist Devices
Physiology
Left ventricular assist devices
Cardiovascular system
Cardiac Output
Hemodynamics
Vascular Resistance
High Cardiac Output
Inferior Vena Cava
Heart Transplantation
Cardiovascular System
Arterial Pressure
Pressure
Lung

Keywords

  • Congenital heart disease
  • Lumped parameter model
  • Ventricular assist device

ASJC Scopus subject areas

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

Cite this

Use of Ventricular Assist Device in Univentricular Physiology : The Role of Lumped Parameter Models. / Di Molfetta, Arianna; Ferrari, Gianfranco; Filippelli, Sergio; Fresiello, Libera; Iacobelli, Roberta; Gagliardi, Maria G.; Amodeo, Antonio.

In: Artificial Organs, 2015.

Research output: Contribution to journalArticle

Di Molfetta, Arianna ; Ferrari, Gianfranco ; Filippelli, Sergio ; Fresiello, Libera ; Iacobelli, Roberta ; Gagliardi, Maria G. ; Amodeo, Antonio. / Use of Ventricular Assist Device in Univentricular Physiology : The Role of Lumped Parameter Models. In: Artificial Organs. 2015.
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abstract = "Failing single-ventricle (SV) patients might benefit from ventricular assist devices (VADs) as a bridge to heart transplantation. Considering the complex physiopathology of SV patients and the lack of established experience, the aim of this work was to realize and test a lumped parameter model of the cardiovascular system, able to simulate SV hemodynamics and VAD implantation effects. Data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Additionally, both the effects of ventricular assistance and cavopulmonary assistance were simulated in different pathologic conditions on Fontan patients, including systolic dysfunction, diastolic dysfunction, and pulmonary vascular resistance increment. The model can reproduce patients' baseline well. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output (CO) in all the three palliation conditions (Norwood 77.2{\%}, Glenn 38.6{\%}, and Fontan 17.2{\%}); (ii) decreases the SV external work (SVEW) (Norwood 55{\%}, Glenn 35.6{\%}, and Fontan 41{\%}); (iii) increases the mean pulmonary arterial pressure (Pap) (Norwood 39.7{\%}, Glenn 12.1{\%}, and Fontan 3{\%}). In Fontan circulation, with systolic dysfunction, the left VAD (LVAD) increases CO (35{\%}), while the right VAD (RVAD) determines a decrement of inferior vena cava pressure (Pvci) (39{\%}) with 34{\%} increment of CO. With diastolic dysfunction, the LVAD increases CO (42{\%}) and the RVAD decreases the Pvci. With pulmonary vascular resistance increment, the RVAD allows the highest CO (50{\%}) increment with the highest decrement of Pvci (53{\%}). The single ventricular external work (SVEW) increases (decreases) increasing the VAD speed in cavopulmonary (ventricular) assistance. Numeric models could be helpful in this challenging and innovative field to support patients and VAD selection to optimize the clinical outcome and personalize the therapy.",
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