Can Simulation Become a Preoperative Planning Approach in Patients Requiring Mechanical Circulatory Support?

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 seem a suitable choice because of their simplicity and versatility. They show great flexibility in haemodynamic simulation and maintain the ability to be run in real time on desktop, laptop or mobile devices. This approach has a great potential for application in heart failure and mechanical circulatory support. Aim: We sought to investigate the value of simulation in the context of three heart failure patients already discussed at a multi-disciplinary team meeting with a view to predict or guide further management and compare the outcome with the clinical decision. Methods: Simulations were run with CARDIOSIM©, a software package developed by the Institute of Clinical Physiology, CNR, Rome, Italy. The software is interactive and based on lumped parameter models and on a modular approach with an updatable library of numerical models of different sections of the cardiovascular system, which can be assembled according to the need of the simulation. Result: The outcome of the simulations either agreed or challenged the clinical decision. Remarkable agreement between measured and simulated data was observed. Conclusion: Patient-specific modelling may become a daily approach for the selection and optimisation of device-based treatment for heart failure patients. A simulation setting may add a more quantitative approach and help the decision process.