Biventricular Finite Element Modeling of the Acorn CorCap Cardiac Support Device on a Failing Heart

Wenk, Jonathan F.; Ge, Liang; Zhang, Zhihong; Mojsejenko, Dimitri; Potter, D. Dean; Tseng, Elaine; Guccione, Julius M.; Ratcliffe, Mark B.

doi:10.1016/j.athoracsur.2013.02.032

Cited by 25 publications

(19 citation statements)

References 19 publications

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“…Nevertheless, our laboratory has found ED and ES LV pressure-volume relationships and mean myofiber stresses to be extremely valuable in evaluating the efficacy of novel medical and/or surgical procedures and devices for treating ischemic cardiomyopathies (5,9,21,22,31,33,36,38,40,48,54,58,59,61,64,65,70).…”

Section: Discussionmentioning

confidence: 99%

Distribution of normal human left ventricular myofiber stress at end diastole and end systole: a target for in silico design of heart failure treatments

Genet

Lee

Nguyen

et al. 2014

Journal of Applied Physiology

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Ventricular wall stress is believed to be responsible for many physical mechanisms taking place in the human heart, including ventricular remodeling, which is frequently associated with heart failure. Therefore, normalization of ventricular wall stress is the cornerstone of many existing and new treatments for heart failure. In this paper, we sought to construct reference maps of normal ventricular wall stress in humans that could be used as a target for in silico optimization studies of existing and potential new treatments for heart failure. To do so, we constructed personalized computational models of the left ventricles of five normal human subjects using magnetic resonance images and the finite-element method. These models were calibrated using left ventricular volume data extracted from magnetic resonance imaging (MRI) and validated through comparison with strain measurements from tagged MRI (950 ± 170 strain comparisons/subject). The calibrated passive material parameter values were C0 = 0.115 ± 0.008 kPa and B0 = 14.4 ± 3.18; the active material parameter value was Tmax = 143 ± 11.1 kPa. These values could serve as a reference for future construction of normal human left ventricular computational models. The differences between the predicted and the measured circumferential and longitudinal strains in each subject were 3.4 ± 6.3 and 0.5 ± 5.9%, respectively. The predicted end-diastolic and end-systolic myofiber stress fields for the five subjects were 2.21 ± 0.58 and 16.54 ± 4.73 kPa, respectively. Thus these stresses could serve as targets for in silico design of heart failure treatments.

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Section: Discussionmentioning

confidence: 99%

Distribution of normal human left ventricular myofiber stress at end diastole and end systole: a target for in silico design of heart failure treatments

Genet

Lee

Nguyen

et al. 2014

Journal of Applied Physiology

Self Cite

130

142

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“…Devices that wrap completely around the epicardium, and are made of synthetic materials, have been investigated and found to acutely reduce wall stress at the expense of reducing pump function. 32 …”

Section: Discussionmentioning

confidence: 99%

Experimental and Computational Investigation of Altered Mechanical Properties in Myocardium after Hydrogel Injection

et al. 2013

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The material properties of myocardium are an important determinant of global left ventricular function. Myocardial infarction results in a series of maladaptive geometric alterations which lead to increased stress and risk of heart failure. In vivo studies have demonstrated that material injection can mitigate these changes. More importantly, the material properties of these injectates can be tuned to minimize wall thinning and ventricular dilation. The current investigation combines experimental data and finite element modeling to correlate how injectate mechanics and volume influence myocardial wall stress. Experimentally, mechanics were characterized with biaxial testing and injected hydrogel volumes were measured with magnetic resonance imaging. Injection of hyaluronic acid hydrogel increased the stiffness of the myocardium/hydrogel composite region in an anisotropic manner, significantly increasing the modulus in the longitudinal direction compared to control myocardium. Increased stiffness, in combination with increased volume from hydrogel injection, reduced the global average fiber stress by ~14% and the transmural average by ~26% in the simulations. Additionally, stiffening in an anisotropic manner enhanced the influence of hydrogel treatment in decreasing stress. Overall, this work provides insight on how injectable biomaterials can be used to attenuate wall stress and provides tools to further optimize material properties for therapeutic applications.

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“…In the past, cardiac support devices, such as a woven polyester jacket and a nitinol mesh placed around the heart, were used in patients with severe heart failure. These clinical studies demonstrated prevention of further dilatation of the LV, promotion of reverse cardiac remodeling, and improvement in symptoms (6,28), which was likely attributable to reduced wall stress (29). The epicardial serpentine mesh also showed a beneficial effect to reduce wall stress in a postinfarct rat heart without worsening diastolic function.…”

Section: Discussionmentioning

confidence: 87%

Electromechanical cardioplasty using a wrapped elasto-conductive epicardial mesh

et al. 2016

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Heart failure remains a major public health concern with a 5-year mortality rate higher than that of most cancers. Myocardial disease in heart failure is frequently accompanied by impairment of the specialized electrical conduction system and myocardium. We introduce an epicardial mesh made of electrically conductive and mechanically elastic material, to resemble the innate cardiac tissue and confer cardiac conduction system function, to enable electromechanical cardioplasty. Our epicardium-like substrate mechanically integrated with the heart and acted as a structural element of cardiac chambers. The epicardial device was designed with elastic properties nearly identical to the epicardial tissue itself and was able to detect electrical signals reliably on the moving rat heart without impeding diastolic function 8 weeks after induced myocardial infarction. Synchronized electrical stimulation over the ventricles by the epicardial mesh with the high conductivity of 11,210 S/cm shortened total ventricular activation time, reduced inherent wall stress, and improved several measures of systolic function including increases of 51% in fractional shortening,~90% in radial strain, and 42% in contractility. The epicardial mesh was also capable of delivering an electrical shock to terminate a ventricular tachyarrhythmia in rodents. Electromechanical cardioplasty using an epicardial mesh is a new pathway toward reconstruction of the cardiac tissue and its specialized functions.

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Biventricular Finite Element Modeling of the Acorn CorCap Cardiac Support Device on a Failing Heart

Cited by 25 publications

References 19 publications

Distribution of normal human left ventricular myofiber stress at end diastole and end systole: a target for in silico design of heart failure treatments

Distribution of normal human left ventricular myofiber stress at end diastole and end systole: a target for in silico design of heart failure treatments

Experimental and Computational Investigation of Altered Mechanical Properties in Myocardium after Hydrogel Injection

Electromechanical cardioplasty using a wrapped elasto-conductive epicardial mesh

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