What is the clinical evidence from this study?

Study design: Case Report. Population: Advanced heart failure (n=3). Intervention: Simulation using CARDIOSIM© vs. Standard clinical decision-making. Primary outcome: Haemodynamic parameters (EDV, ESV, Ea/Ees ratio) during simulated LVAD support.

May 2, 2018Open Access

Simulation as a preoperative planning approach in advanced heart failure patients. A retrospective clinical analysis

MCMassimo CapocciaNorthern General Hospital SMSilvia MarconiSapienza University of Rome SSSanjeet Singh Avtaar SinghEdinburgh Royal Infirmary

Key Result

Patient-specific modelling using CARDIOSIM© successfully simulated the haemodynamic effects of LVAD support, demonstrating its potential value as a quantitative tool for preoperative planning in advanced heart failure.

Study Design

Type

Case Report (n=3)

Structured PICO

Does patient-specific computational simulation accurately model hemodynamic responses to LVAD support in advanced heart failure patients?

Population

3 advanced heart failure patients (n=3) previously discussed at a multidisciplinary meeting, including one with anterior MI (EF 27%), one with hypertrophic cardiomyopathy (EF 45%), and one with prior MI/CABG (EF 15%).

Intervention

Patient-specific computational modeling and simulation using CARDIOSIM software to evaluate hemodynamic responses to left ventricular assist device (LVAD) support with and without milrinone.

Comparator

Baseline (admission) measured hemodynamic status without LVAD support.

Outcome

Simulated hemodynamic parameters (including end-diastolic volume, end-systolic volume, arterial elastance, and Ea/Ees ratio) compared to measured parameters.surrogate

Patient-specific computational modeling can simulate hemodynamic responses to LVAD support, potentially aiding in preoperative planning and clinical decision-making for advanced heart failure patients.

Limitations

Retrospective nature of the study
Small sample size of only three patients
Lumped-parameter models provide less detailed predictions of pressure and flow waveforms compared to 3-D CFD models

Abstract

BACKGROUND: Modelling and simulation may become clinically applicable tools for detailed evaluation of the cardiovascular system and clinical decision-making to guide therapeutic intervention. Models based on pressure-volume relationship and zero-dimensional representation of the cardiovascular system may be a suitable choice given their simplicity and versatility. This approach has great potential for application in heart failure where the impact of left ventricular assist devices has played a significant role as a bridge to transplant and more recently as a long-term solution for non eligible candidates. RESULTS: was the software used for this purpose. The study was based on retrospective analysis of haemodynamic data previously discussed at a multidisciplinary meeting. The outcome of the simulations addressed the value of a more quantitative approach in the clinical decision process. CONCLUSIONS: Although previous experience, co-morbidities and the risk of potentially fatal complications play a role in clinical decision-making, patient-specific modelling may become a daily approach for selection and optimisation of device-based treatment for heart failure patients. Willingness to adopt this integrated approach may be the key to further progress.

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