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首页> 外文期刊>Artificial Organs >Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study
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Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study

机译：心室辅助装置植入对Norwood，Glenn和Fontan循环的血流动力学影响：模拟研究

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The growing population of failing single-ventricle (SV) patients might benefit from ventricular assist device (VAD) support as a bridge to heart transplantation. However, the documented experience is limited to isolated case reports. Considering the complex and different physiopathology of Norwood, Glenn, and Fontan patients and the lack of established experience, the aim of this work is to realize and test a lumped parameter model of the cardiovascular system able to simulate SV hemodynamics and VAD implantation effects to support clinical decision. Hemodynamic and echocardiographic 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. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output and the mean arterial systemic pressure in all the three palliation conditions (Norwood 77.2 and 19.7%, Glenn 38.6 and 32.2%, and Fontan 17.2 and 14.2%); (ii) decreases the SV external work (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) decreases the pressure pulsatility index (Norwood 65.2%, Glenn 81.3%, and Fontan 64.8%); (iv) increases the pulmonary arterial pressure in particular in the Norwood circulation (Norwood 39.7%, Glenn 12.1% and Fontan 3%); and (v) decreases the atrial pressure (Norwood 2%, Glenn 10.6%, and Fontan 8.6%). Finally, the VAD work is lower in the Norwood circulation (30.4 mL.mm Hg) in comparison with Fontan (40.3 mL.mm Hg) and to Glenn (64.5 mL.mm Hg) circulations. The use of VAD in SV physiology could be helpful to bridge patients to heart transplantations by increasing the CO and unloading the SV with a decrement of the atrial pressure and the SV external work. The regulation of the pulmonary flow is challenging because the Pap is increased by the presence of VAD. The hemodynamic changes are different in the different SV palliation step. The use of numerical models could be helpful to support patient and VAD selection to optimize the clinical outcome.
机译：越来越多的失败的单心室（SV）患者可能会受益于心室辅助设备（VAD）支持，作为通向心脏移植的桥梁。但是，记录的经验仅限于单独的案例报告。考虑到Norwood，Glenn和Fontan患者的生理病理情况复杂而又不同，并且缺乏经验，该工作的目的是实现和测试能够模拟SV血流动力学和VAD植入效果以支持心血管系统的集总参数模型。临床决策。回顾性收集30例SV患者（10例Norwood，10例Glenn和10例Fontan）的血流动力学和超声心动图数据，并将其用于模拟患者的基线。然后，模拟了VAD植入的效果。模拟结果表明，VAD的植入：（i）在所有三种缓解情况下（Norwood 77.2和19.7％，Glenn 38.6和32.2％，Fontan 17.2和14.2％）都增加心输出量和平均动脉系统压力; （ii）减少SV外部工作（Norwood 55％，Glenn 35.6％和Fontan 41％）; （iii）降低压力脉动指数（诺伍德65.2％，格伦81.3％和方丹64.8％）; （iv）增加肺动脉压，特别是在诺伍德循环中（诺伍德39.7％，格伦12.1％和方丹3％）; （v）降低房压（诺伍德2％，格伦10.6％和方丹8.6％）。最后，与Fontan（40.3 mL.mm Hg）和Glenn（64.5 mL.mm Hg）循环相比，Norwood循环（30.4 mL.mm Hg）中的VAD功较低。在SV生理中使用VAD可能会增加心房压力并降低心房压力和SV的外部功，从而帮助患者桥接心脏移植。肺血流的调节具有挑战性，因为VAD的存在会增加Pap。在不同的SV缓解步骤中，血流动力学变化是不同的。数值模型的使用可能有助于支持患者和VAD的选择，以优化临床结果。

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