Hemodynamic Impact of the C‐Pulse Cardiac Support Device: A One‐Dimensional Arterial Model Study

Arias, Daimé Campos; Londoño, Federico Uribe; Moliner, Tania Rodríguez; Georgakopoulos, Dimitrios; Stergiopulos, Nikolaos; Segers, Patrick

doi:10.1111/aor.12922

Cited by 5 publications

(5 citation statements)

References 24 publications

(32 reference statements)

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“…When actuated during optimal setting actuation ( p act = 12 psi, delay = 650 ms), an additional diastolic pressure and flow waveform is observed in all cardiovascular branches, which is inline with previous studies ( 34 ). The effect on systolic aortic pressure is similar to previous in vivo studies about IABPs and the C-Pulse System, however the cardiac output is increased to a much lesser extent ( 18 , 21 , 39 , 40 ). While the effect on decreasing aortic pressure is similar, the soft robotic device prototype covers a significantly smaller aortic arch length then the C-pulse system.…”

Section: Discussionsupporting

confidence: 84%

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Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support

Arduini

Pham

Marsden

et al. 2022

Front. Cardiovasc. Med.

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Despite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatment options. Modeling can provide a framework for evaluating alternative treatment strategies. Counterpulsation strategies have the capacity to improve left ventricular diastolic filling by reducing systolic blood pressure and augmenting the diastolic pressure that drives coronary perfusion. Here, we propose a framework for testing the effectiveness of a soft robotic extra-aortic counterpulsation strategy using a patient-specific closed-loop hemodynamic lumped parameter model of a patient with HFpEF. The soft robotic device prototype was characterized experimentally in a physiologically pressurized (50–150 mmHg) soft silicone vessel and modeled as a combination of a pressure source and a capacitance. The patient-specific model was created using open-source software and validated against hemodynamics obtained by imaging of a patient (male, 87 years, HR = 60 bpm) with HFpEF. The impact of actuation timing on the flows and pressures as well as systolic function was analyzed. Good agreement between the patient-specific model and patient data was achieved with relative errors below 5% in all categories except for the diastolic aortic root pressure and the end systolic volume. The most effective reduction in systolic pressure compared to baseline (147 vs. 141 mmHg) was achieved when actuating 350 ms before systole. In this case, flow splits were preserved, and cardiac output was increased (5.17 vs. 5.34 L/min), resulting in increased blood flow to the coronaries (0.15 vs. 0.16 L/min). Both arterial elastance (0.77 vs. 0.74 mmHg/mL) and stroke work (11.8 vs. 10.6 kJ) were decreased compared to baseline, however left atrial pressure increased (11.2 vs. 11.5 mmHg). A higher actuation pressure is associated with higher systolic pressure reduction and slightly higher coronary flow. The soft robotic device prototype achieves reduced systolic pressure, reduced stroke work, slightly increased coronary perfusion, but increased left atrial pressures in HFpEF patients. In future work, the framework could include additional physiological mechanisms, a larger patient cohort with HFpEF, and testing against clinically used devices.

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Section: Discussionsupporting

confidence: 84%

“…The device modeling was inspired by previous work on modeling counterpulsation devices in lumped parameter and 1D models ( 38 , 39 ). Our approach informed the device model directly from an experimental analysis of the studied counterpulsation device prototype.…”

Section: Discussionmentioning

confidence: 99%

Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support

Arduini

Pham

Marsden

et al. 2022

Front. Cardiovasc. Med.

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“…The present study aimed to develop a 1D computer model for the equine arterial circulation comprising all major vessels of the arterial tree. The original 1D human model on which this equine model is based, has been validated and is used as a research tool in many studies [5, 32–35]. Recently, it formed the basis for the development of a 1D model in mice [36].…”

Section: Discussionmentioning

confidence: 99%

A 1D computer model of the arterial circulation in horses: An important resource for studying global interactions between heart and vessels under normal and pathological conditions

et al. 2019

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Arterial rupture in horses has been observed during exercise, after phenylephrine administration or during parturition (uterine artery). In human pathophysiological research, the use of computer models for studying arterial hemodynamics and understanding normal and abnormal characteristics of arterial pressure and flow waveforms is very common. The objective of this research was to develop a computer model of the equine arterial circulation, in order to study local intra-arterial pressures and flow dynamics in horses. Morphologically, large differences exist between human and equine aortic arch and arterial branching patterns. Development of the present model was based on post-mortem obtained anatomical data of the arterial tree (arterial lengths, diameters and branching angles); in vivo collected ultrasonographic flow profiles from the common carotid artery, external iliac artery, median artery and aorta; and invasively collected pressure curves from carotid artery and aorta. These data were used as input for a previously validated (in humans) 1D arterial network model. Data on terminal resistance and arterial compliance parameters were tuned to equine physiology. Given the large arterial diameters, Womersley theory was used to compute friction coefficients, and the input into the arterial system was provided via a scaled time-varying elastance model of the left heart. Outcomes showed plausible predictions of pressure and flow waveforms throughout the considered arterial tree. Simulated flow waveform morphology was in line with measured flow profiles. Consideration of gravity further improved model based predicted waveforms. Derived flow waveform patterns could be explained using wave power analysis. The model offers possibilities as a research tool to predict changes in flow profiles and local pressures as a result of strenuous exercise or altered arterial wall properties related to age, breed or gender.

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“…At the extruded inlet, a pulsatile waveform with a period of 0.8 s and a minimum/mean/max inflow velocity of 0.041/0.121/0.260 m/s was prescribed (see Figure 4 ). The waveform was derived from an in-house 1D model of the arterial circulation in humans ( Campos Arias et al, 2017 ) and scaled so that the average inflow equaled the inflow as determined by the outlet boundary conditions (see below). Particles were injected every 0.01 s throughout the third cycle (allowing two prior cycles for flow development).…”

Section: Methodsmentioning

confidence: 99%

A Hybrid Particle-Flow CFD Modeling Approach in Truncated Hepatic Arterial Trees for Liver Radioembolization: A Patient-specific Case Study

Bomberna

Vermijs

Lejoly

et al. 2022

Front. Bioeng. Biotechnol.

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Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. At its intermediate, unresectable stage, HCC is typically treated by local injection of embolizing microspheres in the hepatic arteries to selectively damage tumor tissue. Interestingly, computational fluid dynamics (CFD) has been applied increasingly to elucidate the impact of clinically variable parameters, such as injection location, on the downstream particle distribution. This study aims to reduce the computational cost of such CFD approaches by introducing a novel truncation algorithm to simplify hepatic arterial trees, and a hybrid particle-flow modeling approach which only models particles in the first few bifurcations. A patient-specific hepatic arterial geometry was pruned at three different levels, resulting in three trees: Geometry 1 (48 outlets), Geometry 2 (38 outlets), and Geometry 3 (17 outlets). In each geometry, 1 planar injection and 3 catheter injections (each with different tip locations) were performed. For the truncated geometries, it was assumed that, downstream of the truncated outlets, particles distributed themselves proportional to the blood flow. This allowed to compare the particle distribution in all 48 “outlets” for each geometry. For the planar injections, the median difference in outlet-specific particle distribution between Geometry 1 and 3 was 0.21%; while the median difference between outlet-specific flow and particle distribution in Geometry 1 was 0.40%. Comparing catheter injections, the maximum median difference in particle distribution between Geometry 1 and 3 was 0.24%, while the maximum median difference between particle and flow distribution was 0.62%. The results suggest that the hepatic arterial tree might be reliably truncated to estimate the particle distribution in the full-complexity tree. In the resulting hybrid particle-flow model, explicit particle modeling was only deemed necessary in the first few bifurcations of the arterial tree. Interestingly, using flow distribution as a surrogate for particle distribution in the entire tree was considerably less accurate than using the hybrid model, although the difference was much higher for catheter injections than for planar injections. Future work should focus on replicating and experimentally validating these results in more patient-specific geometries.

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Hemodynamic Impact of the C‐Pulse Cardiac Support Device: A One‐Dimensional Arterial Model Study

Cited by 5 publications

References 24 publications

Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support

Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support

A 1D computer model of the arterial circulation in horses: An important resource for studying global interactions between heart and vessels under normal and pathological conditions

A Hybrid Particle-Flow CFD Modeling Approach in Truncated Hepatic Arterial Trees for Liver Radioembolization: A Patient-specific Case Study

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