Predicting the risk of post-hepatectomy portal hypertension using a digital twin: A clinical proof of concept
Predicting the risk of post-hepatectomy portal hypertension using a digital twin: A clinical proof of concept
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DOI：
10.1016/j.jhep.2020.10.036
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发表时间：
2021-02-15
影响因子：
25.7
通讯作者：
Vignon-Clementel, Irene E.
中科院分区：
文献类型：
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作者：
Golse, Nicolas;Joly, Florian;Vignon-Clementel, Irene E.
背景与目的：尽管内科和外科技术不断进步，但肝切除术后肝功能衰竭(PHLF)仍然是术后死亡的主要原因。术后高门静脉压力(P-PV)和门腔静脉压差(PCG)是PHLF的最重要的决定因素，而目前的方法无法预测这些因素。因此，我们旨在评估数字双胞胎来预测术后门脉高压(PHT)的风险。方法：我们前瞻性地纳入了47名接受大范围肝切除术的患者。评估了整个血液循环的数学(0D)模型，并根据患者的特征进行了自动校准。肝血流通过术前血流磁共振(n=9)、术中血流测量(n=16)或根据心输出量(n=47)估计。结果：3组模拟的术后压力与收集的数据比较无显著差异(P>0.0 5)。在整个队列中，P-PV值的实测值和模拟值之间的相关性良好(r=0.66，不受术中事件的影响)或调整后良好(r=0.75)，PCG的相关性也很好(分别为r=0.59和r=0.80)。模拟和测量的术后PCG的差异是
Background & Aims: Despite improvements in medical and surgical techniques, post-hepatectomy liver failure (PHLF) remains the leading cause of postoperative death. High postoperative portal vein pressure (P-PV) and portocaval gradient (PCG), which cannot be predicted by current tools, are the most important determinants of PHLF. Therefore, we aimed to evaluate a digital twin to predict the risk of postoperative portal hypertension (PHT).Methods: We prospectively included 47 patients undergoing major hepatectomy. A mathematical (0D) model of the entire blood circulation was assessed and automatically calibrated from patient characteristics. Hepatic flows were obtained from preoperative flow MRI (n = 9), intraoperative flowmetry (n = 16), or estimated from cardiac output (n = 47). Resection was then simulated in these 3 groups and the computed Ppv and PCG were compared to intraoperative data.Results: Simulated post-hepatectomy pressures did not differ between the 3 groups, comparing well with collected data (no significant differences). In the entire cohort, the correlation between measured and simulated P-PV values was good (r = 0.66, no adjustment to intraoperative events) or excellent (r = 0.75) after adjustment, as well as for PCG (respectively r = 0.59 and r = 0.80). The difference between simulated and measured posthepatectomy PCG was