关于心脏摘除术后双心室辅助对血管流动生理学影响的预测:数值研究

IF 5.3 2区 医学 Q1 ENGINEERING, BIOMEDICAL Biocybernetics and Biomedical Engineering Pub Date : 2024-01-01 DOI:10.1016/j.bbe.2023.12.005
Louis Marcel , Mathieu Specklin , Smaine Kouidri , Mickael Lescroart , Jean-Louis Hébert
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引用次数: 0

摘要

心力衰竭是一种慢性进行性疾病,其特点是心脏无法泵出足够的血液来满足人体的代谢需求。它是全球关注的重大公共卫生问题,与高发病率、高死亡率和高医疗成本有关。对于药物治疗无效的晚期心力衰竭病例,可以考虑心脏移植或使用心室辅助装置(VAD)进行机械循环支持。在双心室心力衰竭的特殊情况下,需要替换两个心室。在这种情况下,可以建议使用全人工心脏(TAH)作为移植方案的桥梁。此外,双心室辅助装置(BiVAD)可同时支持两个心室。然而,双心室心力衰竭治疗困难重重,疗效不佳。新的外科手术似乎为双心室衰竭提出了解决方案。其中一种干预方法是在心肌肉瘤导致心脏切除后,使用两个连续流 VAD 作为全人工心脏。遗憾的是,由于手术后无法再测量肺动脉压力和血流速度,因此这种手术给患者管理带来了很大困难。因此,两种泵的设置对于患者管理来说是一项复杂的任务。本文的目的是通过使用集合模型预测所有可能的转速组合在血管网格上产生的不同结果,从而帮助临床医生管理心脏摘除术后接受双重辅助的患者。结果提供了在结合降压治疗时适合向血管网提供生理适应流量的两种泵运行条件的范围。
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On the prediction of the effect of bi-ventricular assistance after cardiac explantation on the vascular flow physiology: A numerical study

Heart failure is a chronic and progressive condition characterized by the heart’s inability to pump sufficient blood to meet the body’s metabolic demands. It is a significant public health concern worldwide, associated with high morbidity, mortality, and healthcare costs. For advanced heart failure cases not responding to medical therapy, heart transplantation or mechanical circulatory support with ventricular assist devices (VADs) can be considered. In the specific case of bi-ventricular heart failure a replacement of both ventricles is required. In this context a Total Artificial Heart (TAH) may be proposed as a bridge to transplant solution. Additionally, bi-ventricular assist devices (BiVADs) are available to support both ventricles simultaneously. However Bi-ventricular heart failure management is difficult with poor outcomes. New surgical procedures appear to propose solutions after both ventricle failure. One of these intervention uses two continuous-flow VADs as a total artificial heart after cardiac explantation due to myocardial sarcoma. Unfortunately, this procedure makes patient management very difficult as pulmonary pressures and flow rate are no longer measurable after the surgical procedure. The setting of both pumps is hence a complex task for patient management. This article aims at helping clinicians on patient management undergoing double assistance after cardiac explantation by predicting the different outcomes on the vascular grid for all the possible rotational speed combination using a lumped model. Results provide a range of both pump operating conditions suitable for delivering a physiologically adapted flow to the vascular grid when combined with hypotensive treatments.

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来源期刊
CiteScore
16.50
自引率
6.20%
发文量
77
审稿时长
38 days
期刊介绍: Biocybernetics and Biomedical Engineering is a quarterly journal, founded in 1981, devoted to publishing the results of original, innovative and creative research investigations in the field of Biocybernetics and biomedical engineering, which bridges mathematical, physical, chemical and engineering methods and technology to analyse physiological processes in living organisms as well as to develop methods, devices and systems used in biology and medicine, mainly in medical diagnosis, monitoring systems and therapy. The Journal''s mission is to advance scientific discovery into new or improved standards of care, and promotion a wide-ranging exchange between science and its application to humans.
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