Use of patient-specific computational models for optimization of aortic insufficiency after implantation of left ventricular assist device.
Use of patient-specific computational models for optimization of aortic insufficiency after implantation of left ventricular assist device.
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DOI：
10.1016/j.jtcvs.2020.04.164
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Hiesinger W
中科院分区：
文献类型：
--
作者：
Kasinpila P;Kong S;Fong R;Shad R;Kaiser AD;Marsden AL;Woo YJ;Hiesinger W
据观察，在连续流 LVAD 人群中，主动脉瓣关闭不全 (AI) 会加速，并且与死亡率增加有关。使用计算流体动力学 (CFD)，我们研究了这些患者与 LVAD 流出方向相关的血流动力学条件。我们确定了 2009 年至 2018 年间 LVAD 植入后 10 名新出现主动脉瓣反流的患者，以及 20 名未出现主动脉瓣反流的患者。根据患者的 CT 扫描创建了患者主动脉的三维模型。使用方位角、极角和距主动脉根部的距离对 LVAD 流出移植物相对于主动脉的几何形状进行量化。该模型用于运行 CFD 模拟，计算施加在主动脉根部的压力和壁剪切应力 (rWSS)。发现方位角 (AA) 和极角 (PA) 相似。然而，对于高 AA 值和低 PA 值的组合，没有患者患有 AI。发生 AI 的患者从主动脉根部到流出移植物的距离也更小（3.39 ± 0.7 vs 4.07 ± 0.77cm，p = 0.04）。两组主动脉根部压力无显着差异。 AI 患者的 rWSS 较高（4.60 ± 5.70 vs 2.37 ± 1.20 dyne/cm2，p < 0.001）。定性地，我们观察到 AI 组中存在更大的扰动、高 rWSS 区域和流动涡流的趋势。通过 CFD 模拟，我们证明发生 de novo AI 的患者在主动脉根部具有更大的 rWSS，并且与未发生 de novo AI 的患者相比，他们的流出移植物放置得更靠近主动脉根部。
Aortic insufficiency (AI) is observed to be accelerated in the continuous-flow LVAD population and is related to increased mortality. Using computational fluid dynamics (CFD), we investigated the hemodynamic conditions related to the orientation of the LVAD outflow in these patients. We identified 10 patients with new aortic regurgitation, and 20 who did not, after LVAD implantation between 2009–2018. Three-dimensional models of patients’ aortas were created from their CT scans. The geometry of the LVAD outflow graft in relation to the aorta was quantified using azimuth, polar angles, and distance from aortic root. The models were used to run CFD simulations which calculated the pressures and wall shear stress (rWSS) exerted on the aortic root. The azimuth (AA) and polar angles (PA) were found to be similar. However, for combinations of high values of AA and low values of PA, there were no patients with AI. The distance from aortic root to the outflow graft was also smaller in patients who developed AI (3.39 ± 0.7 vs 4.07 ± 0.77cm, p = 0.04). There was no significant difference in aortic root pressures in the two groups. The rWSS was higher in AI patients (4.60 ± 5.70 vs 2.37 ± 1.20 dyne/cm2, p < 0.001). Qualitatively, we observed a trend of greater perturbations, regions of high rWSS, and flow eddies in the AI group. Using CFD simulations, we demonstrated that patients who developed de novo AI have greater rWSS at the aortic root, and their outflow grafts were placed closer to the aortic roots than those patients without de novo AI.
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DOI：
10.1097/mat.0000000000000443
发表时间：
2017
期刊：
ASAIO journal (American Society for Artificial Internal Organs : 1992)
影响因子：
--
作者：
Aliseda A;Chivukula VK;Mcgah P;Prisco AR;Beckman JA;Garcia GJ;Mokadam NA;Mahr C
通讯作者：
Mahr C
影响因子：
3.8
作者：
Updegrove A;Wilson NM;Merkow J;Lan H;Marsden AL;Shadden SC
通讯作者：
Shadden SC
影响因子：
--
作者：
Holtz, Jonathan;Teuteberg, Jeffrey
通讯作者：
Teuteberg, Jeffrey
影响因子：
8.9
作者：
Fried, Justin;Garan, Arthur R.;Topkara, Veli K.
通讯作者：
Topkara, Veli K.
影响因子：
4.2
作者：
Deo, Salil V.;Sharma, Vikas;Park, Soon J.
通讯作者：
Park, Soon J.