Biventricular finite element modeling of the Acorn CorCap Cardiac Support Device on a failing heart.
Biventricular finite element modeling of the Acorn CorCap Cardiac Support Device on a failing heart.
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对衰竭心脏的 Acorn CorCap 心脏支持装置进行双心室有限元建模。
DOI：
10.1016/j.athoracsur.2013.02.032
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Ratcliffe,MarkB
中科院分区：
文献类型：
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作者：
Wenk,JonathanF;Ge,Liang;Zhang,Zhihong;Mojsejenko,Dimitri;Potter,DDean;Tseng,ElaineE;Guccione,JuliusM;Ratcliffe,MarkB
背景橡子冠帽心脏支持装置(CSD；橡树心血管公司，圣保罗，明尼苏达州)是一种编织的聚酯夹克，放置在心脏周围，旨在逆转与扩张型心肌病相关的渐进性重构。然而，橡子CSD对心肌纤维应激和心功能的影响尚不清楚。我们验证了橡子CSD降低舒张末(ED)肌纤维应力的假设。方法采用先前描述的弱耦合双室有限元(FE)模型和基于扩张型心肌病犬磁共振图像的循环模型。分别对单纯CSD(橡子)、纤维取向旋转的CSD(旋转)、5%预拉伸的CSD(紧张型)和仅包绕左心室的CSD(仅LV)进行虚拟应用，并计算其对ED的肌纤维应力和泵功能的影响。结果橡子CSD对左心室游离壁的ED肌纤维应力有较大影响，分别降低55%、79%、92%和40%。然而，橡子CSD在橡子、旋转、紧致和仅有LV的情况下，在LV舒张末压力为8 mm Hg时，每搏量分别减少23%、25%、30%和7%。结论橡子CSD显著降低ED肌纤维应力。然而，仅包裹在左心室周围的CSD是唯一对泵功能影响最小的病例。研究结果表明，仅使用LV的CSD和橡子织物的取向应该得到优化，以最大限度地减少肌纤维应力，同时最大限度地降低泵功能。
BACKGROUNDThe Acorn CorCap Cardiac Support Device (CSD; Acorn Cardiovascular Inc, St. Paul, MN) is a woven polyester jacket that is placed around the heart and designed to reverse the progressive remodeling associated with dilated cardiomyopathy. However, the effects of the Acorn CSD on myofiber stress and ventricular function remain unknown. We tested the hypothesis that the Acorn CSD reduces end-diastolic (ED) myofiber stress.METHODSA previously described weakly coupled biventricular finite element (FE) model and circulatory model based on magnetic resonance images of a dog with dilated cardiomyopathy was used. Virtual applications of the CSD alone (Acorn), CSD with rotated fabric fiber orientation (rotated), CSD with 5% prestretch (tight), and CSD wrapped only around the left ventricle (LV; LV-only) were performed, and the effect on myofiber stress at ED and pump function was calculated.RESULTSThe Acorn CSD has a large effect on ED myofiber stress in the LV free wall, with reductions of 55%, 79%, 92%, and 40% in the Acorn, rotated, tight, and LV-only cases, respectively. However, there is a tradeoff in which the Acorn CSD reduces stroke volume at LV end-diastolic pressure of 8 mm Hg by 23%, 25%, 30%, and 7%, respectively, in the Acorn, rotated, tight, and LV-only cases.CONCLUSIONSThe Acorn CSD significantly reduces ED myofiber stress. However, CSD wrapped only around the LV was the only case with minimal negative effect on pump function. Findings suggest that LV-only CSD and Acorn fabric orientation should be optimized to allow maximal myofiber stress reduction with minimal reduction in pump function.