A Novel computational approach to optimize Fontan and improve surgical predictability

一种优化 Fontan 并提高手术可预测性的新型计算方法

• 批准号: 10557238
• 负责人: Vijay Govindarajan
• 金额: $ 59.82万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557238
• 关键词: Adult; Affect; Algorithms; Anatomy; Aneurysm; Arteriovenous malformation; Assessment tool; Biochemistry; Blood; Blood Platelets; Blood coagulation; Blood flow; Cardiac; Cardiac Surgery procedures; Caring; Childhood; Circulation; Clinical; Coagulation Process; Collection; Complex; Consumption; Coupled; Custom; Data; Deposition; Diameter; Distal; Engineering; Environment; Equilibrium; Evaluation; Failure; Family suidae; Fibrin; Flare; Fontan Procedure; Gases; Geometry; Heart; Hematologist; Hepatic; Image; In Vitro; Intervention; Life; Liquid substance; Liver; Lung; Magnetic Resonance Imaging; Manuals; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Operative Surgical Procedures; Organ; Outcome; Palliative Care; Pathway interactions; Patients; Physiology; Play; Polytetrafluoroethylene; Postoperative Period; Proteins; Protocols documentation; Research; Risk; Role; Route; Shapes; Single ventricle congenital heart disease; Surgeon; Techniques; Thrombin; Thrombosis; Thrombus; Time; Validation; Variant; Venous; Ventricular; Work; aortic arch; biochemical model; blood pump; clinical application; cohort; comparative; computerized tools; congenital heart disorder; design; hemodynamics; improved; in silico; in vitro Model; insight; kidney dysfunction; mortality; multidisciplinary; novel; palliative; pressure; prevent; prospective; reconstruction; repaired; success; surgery outcome; thrombotic; tool; virtual; virtual surgery; Adult; Affect; Algorithms; Anatomy; Aneurysm; Arteriovenous malformation; Assessment tool; Biochemistry; Blood; Blood Platelets; Blood coagulation; Blood flow; Cardiac; Cardiac Surgery procedures; Caring; Childhood; Circulation; Clinical; Coagulation Process; Collection; Complex; Consumption; Coupled; Custom; Data; Deposition; Diameter; Distal; Engineering; Environment; Equilibrium; Evaluation; Failure; Family suidae; Fibrin; Flare; Fontan Procedure; Gases; Geometry; Heart; Hematologist; Hepatic; Image; In Vitro; Intervention; Life; Liquid substance; Liver; Lung; Magnetic Resonance Imaging; Manuals; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Operative Surgical Procedures; Organ; Outcome; Palliative Care; Pathway interactions; Patients; Physiology; Play; Polytetrafluoroethylene; Postoperative Period; Proteins; Protocols documentation; Research; Risk; Role; Route; Shapes; Single ventricle congenital heart disease; Surgeon; Techniques; Thrombin; Thrombosis; Thrombus; Time; Validation; Variant; Venous; Ventricular; Work; aortic arch; biochemical model; blood pump; clinical application; cohort; comparative; computerized tools; congenital heart disorder; design; hemodynamics; improved; in silico; in vitro Model; insight; kidney dysfunction; mortality; multidisciplinary; novel; palliative; pressure; prevent; prospective; reconstruction; repaired; success; surgery outcome; thrombotic; tool; virtual; virtual surgery

An efficient hemodynamics with minimal thrombosis risk post-surgery is essential for short- and long-term success of a cardiac surgery. Achieving this is a challenge in cardiac surgery that involves the design of a complex flow pathway. Aortic arch reconstruction, aneurysm repair, Fontan surgeries are a few examples. The Fontan surgical procedure is the most effective palliative treatment for patients with single ventricle defects (SVD). SVD refers to a collection of congenital heart diseases where one of the lower ventricular chambers of the heart remains underdeveloped. Fontan procedure involves re-routing of deoxygenated blood from upper and lower body to flow directly to lungs allowing the single functioning ventricle to pump blood for systemic circulation. Though lifesaving, the Fontan physiology creates a non-natural pathway for venous return of the blood to the lungs thus producing a non-physiological blood flow. A successful Fontan procedure should involve 1) well-balanced overall and hepatic venous flow return to lungs to prevent pulmonary arteriovenous malformations (PAVMs) that can lead to poor gas exchange, 2) minimal energy loss, and 3) minimal thrombosis (blood clot) risk. Complications such as PAVMs and thrombosis post-surgery can result in a Fontan failure. To improve Fontan surgical planning, its efficacy and predictability, we propose to develop an automated image-based computational fluid dynamics (CFD) workflow capable of optimizing and predicting all the above determinants for a successful Fontan physiology. CFD models have been developed in the past to assess energy loss and hepatic venous flow distribution, but an automated computational tool for rapidly optimizing the patients' Fontan physiology in terms of factors affecting success does not exist. To fill this gap, we will integrate our existing patient-specific Fontan surgical planning protocol to predict energy loss and hepatic venous flow distribution with 1) a shape optimization algorithm and 2) our validated model of blood coagulation to provide a computational tool to virtually improve the planned Fontan physiology for optimal hepatic and overall venous return to lungs, minimal energy loss and thrombotic potential and quantitatively predict thrombosis risk. We will completely automate our workflow with custom scripts to minimize errors and user intervention. Our biochemical model of blood coagulation has all the components representing platelet and fibrin deposition and is 2-way coupled with blood flow. The continuum-based approach of this model allows it to be used in large geometries. After rigorous validation of our surgical optimization workflow using MRI-based patient specific in-vitro models, we will perform virtual surgeries using our tool and retrospective patient data to establish clinical applicability. Our tool could potentially be 1) included in the current surgical planning workflow to perform virtual surgeries using patient pre-op data to improve and predict surgical outcomes, and 2) used to evaluate risk of clotting post- Fontan so that patients can be selectively monitored. Our long-term objective is to provide a prospective surgical planning tool for Fontan and then extend it other surgeries where such optimization can improve surgical efficacy.

在术后进行的有效血液动力学具有最小的血栓形成风险，对于短期和长期至关重要 心脏手术的成功。实现这一目标是心脏手术的挑战，涉及设计 复杂的流道。主动脉弓重建，动脉瘤修复，方坦手术就是一些例子。 Fontan手术程序是单脑室患者的最有效的姑息治疗方法 缺陷（SVD）。 SVD指的是一系列先天性心脏病，其中一种是中心疾病 心脏的室仍然不发达。丰丹手术涉及重新布置去氧血液 从上半身和下半身直接流到肺 全身循环。尽管救生，丰丹生理学为静脉回流创造了一种非天然的途径 血液向肺部产生非生理血流。成功的Fontan程序应该 涉及1）总体平衡和肝静脉流回到肺部以防止肺动脉凹 畸形（PAVM）可能导致气体交换不佳，2）最小能量损失，3）最小血栓形成 （血块）风险。诸如PAVMS和血栓形成之类的并发症会导致Fontan衰竭。 为了改善Fontan手术计划，其功效和可预测性，我们建议开发自动化 基于图像的计算流体动力学（CFD）工作流，能够优化和预测上述所有 成功的方坦生理学的决定因素。过去已经开发了CFD模型来评估能源 损失和肝静脉流量分布，但是快速优化患者的自动计算工具 就影响成功的因素而言，丰丹生理学不存在。为了填补这一空白，我们将整合我们的 现有患者特定的方坦手术计划方案，以预测能量损失和肝静脉流动 用1）分布形状优化算法和2）我们经过验证的血液凝结模型以提供 计算工具几乎改善了计划中的丰丹生理学，以获得最佳肝和整体静脉 恢复到肺部，最小的能量损失和血小板潜力，并定量预测血栓形成风险。我们将 使用自定义脚本完全自动化我们的工作流程，以最大程度地减少错误和用户干预。我们的生化 血液凝血模型具有代表血小板和纤维蛋白沉积的所有成分 结合血流。该模型的基于连续的方法允许将其用于大几何形状。 在使用基于MRI的患者特定体外模型对我们的手术优化工作流进行严格验证后， 我们将使用我们的工具和回顾性患者数据进行虚拟手术，以建立临床适用性。 我们的工具可能是1）包括在当前的手术计划工作流程中进行虚拟手术 使用患者的OP数据改善和预测手术结果，2）用于评估凝结后凝结风险 丰丹可以选择性地监测患者。我们的长期目标是提供预期的手术 为Fontan的计划工具，然后扩展其他手术，在该手术中，这种优化可以提高手术功效。