title: Simulation of acute haemodynamic outcomes of the surgical strategies for the right ventricular failure treatment in pediatric LVAD.
abstract: BACKGROUND
  Right ventricular failure (RVF) is one of the major complications during LVAD. Apart from drug therapy, the most reliable option is the implantation of RVAD. However, BIVAD have a poor prognosis and increased complications. Experiments have been conducted on alternative approaches, such as the creation of an atrial septal defect (ASD), a cavo-aortic shunt (CAS) including the LVAD and a cavo-pulmonary connection (CPC). This work aims at realizing a lumped parameter model (LPM) to compare the acute hemodynamic effects of ASD, CPC, CAS, RVAD in LVAD pediatric patients with RVF.
  
  
  METHODS
  Data of 5 pediatric patients undergoing LVAD were retrospectively collected to reproduce patients baseline hemodynamics with the LPM. The effects of continuous flow LVAD implantation complicated by RVF was simulated and then the effects of ASD, CPC, CAS and RVAD treatments were simulated for each patient.
  
  
  RESULTS
  The model successfully reproduced patients' baseline and the hemodynamic effects of the surgical strategies. Simulating the different surgical strategies, an unloading of the right ventricle and an increment of left ventricular preload were observed with an improvement of the hemodynamics (total cardiac output: ASD +15%, CPC +10%, CAS +70% RVAD +20%; right ventricular external work: ASD -19%, CPC -46%, CAS -76%, RVAD -32%; left ventricular external work: ASD +12%, CPC +28%, RVAD +64%).
  
  
  CONCLUSIONS
  The use of numerical model could offer an additional support for clinical decision-making, also potentially reducing animal experiments, to compare the outcome of different surgical strategies to treat RVF in LVAD.
authors: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome - Italy.
authors: Arianna
authors: A
authors: Di Molfetta
authors: Cardiovascular Engineering Laboratory, Institute of Clinical Physiology, CNR, Rome - Italy.
authors: Gianfranco
authors: G
authors: Ferrari
authors: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome - Italy.
authors: Roberta
authors: R
authors: Iacobelli
authors: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome - Italy.
authors: Sergio
authors: S
authors: Filippelli
authors: Cardiovascular Engineering Laboratory, Institute of Clinical Physiology, CNR, Rome - Italy.
authors: Libera
authors: L
authors: Fresiello
authors: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome - Italy.
authors: Maria G
authors: MG
authors: Gagliardi
authors: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome - Italy.
authors: Alessandro
authors: A
authors: Toscano
authors: Cardiovascular Engineering Laboratory, Institute of Clinical Physiology, CNR, Rome - Italy.
authors: Maria G
authors: MG
authors: Trivella
authors: Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome - Italy.
authors: Antonio
authors: A
authors: Amodeo
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D003198:Computer Simulation; D003661:Decision Support Techniques; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D008955:Models, Cardiovascular; D009716:Numerical Analysis, Computer-Assisted; D018579:Patient Selection; D011474:Prosthesis Design; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right