Patient-Specific Simulations in Interventional Cardiology Practice: Early Results From a Clinical/Engineering Center

Patient-specific models have been recently applied to investigate a wide range of cardiovascular problems including cardiac mechanics, hemodynamic conditions and structural interaction with devices [1]. The development of dedicated computational tools which combined the advances in the field of image elaboration, finite element (FE) and computational fluid-dynamic (CFD) analyses has greatly supported not only the understanding of human physiology and pathology, but also the improvement of specific interventions taking into account realistic conditions [2, 3]. However, the translation of these technologies into clinical applications is still a major challenge for the engineering modeling community, which has to compromise between numerical accuracy and response time in order to meet the clinical needs [4]. Hence, the validation of in silico against in vivo results is crucial. Finally, if the development of novel tools has recently attracted big investments [5], it has not been similarly easy to dedicate funds and time to test the developed technologies on large numbers of patient cases.

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Catheter steering in interventional cardiology: Mechanical analysis and novel solution

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411919877709 ◽

2019 ◽

Vol 233 (12) ◽

pp. 1207-1218 ◽

Cited By ~ 2

Author(s):

Awaz Ali ◽

Aimee Sakes ◽

Ewout A Arkenbout ◽

Paul Henselmans ◽

Remi van Starkenburg ◽

...

Keyword(s):

Degrees Of Freedom ◽

Experimental Validation ◽

Interventional Cardiology ◽

Mechanical Analysis ◽

High Variability ◽

Patient Specific ◽

Proof Of Concept ◽

Future Directions ◽

Bending Angle ◽

Lower Complexity

In recent years, steerable catheters have been developed to combat the effects of the dynamic cardiac environment. Mechanically actuated steerable catheters appear the most in the clinical setting; however, they are bound to a number of mechanical limitations. The aim of this research is to gain insight in these limitations and use this information to develop a new prototype of a catheter with increased steerability. The main limitations in mechanically steerable catheters are identified and analysed, after which requirements and solutions are defined to design a multi-steerable catheter. Finally, a prototype is built and a proof-of-concept test is carried out to analyse the steering functions. The mechanical analysis results in the identification of five limitations: (1) low torsion, (2) shaft shortening, (3) high unpredictable friction, (4) coupled tip-shaft movements, and (5) complex cardiac environment. Solutions are found to each of the limitations and result in the design of a novel multi-steerable catheter with four degrees of freedom. A prototype is developed which allows the dual-segmented tip to be steered over multiple planes and in multiple directions, allowing a range of complex motions including S-shaped curves and circular movements. A detailed analysis of limitations underlying mechanically steerable catheters has led to a new design for a multi-steerable catheter for complex cardiac interventions. The four integrated degrees of freedom provide a high variability of tip directions, and repetition of the bending angle is relatively simple and reliable. The ability to steer inside the heart with a variety of complex shaped curves may potentially change conventional approaches in interventional cardiology towards more patient-specific and lower complexity procedures. Future directions are headed towards further design optimizations and the experimental validation of the prototype.

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Coronary Artery Bypass Surgery or Interventional Cardiology? Why not both? Let’s go for Hybrid Coronary Revascularization

Cardiology Open Access ◽

10.33140/coa.05.01.01 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Coronary Artery Disease ◽

Blood Flow ◽

Cardiac Surgery ◽

Coronary Artery ◽

Minimally Invasive ◽

Artery Bypass ◽

Interventional Cardiology ◽

Heart Team ◽

Early Results ◽

Artery Disease

The options for coronary artery disease have greatly expanded during the course of the last two and half decades with the advent of hybrid technology in the 1990s. The hybrid option for treating cardiac disease implies using the technology of both interventional cardiology and cardiac surgery to offer the patients the best available treatments for coronary artery disease while minimizing the risks of the surgery, example can be a patient with a partial blockage in one coronary artery and a complete blockage in another. In this case, a combination revascularization approach might work best to restore blood flow to the heart muscle. An interventional cardiologist inserts a stent into one coronary artery to open it up, and then a surgeon grafts a bypass vessel to let blood flow around the other blockage. Hybrid Cardiac Surgery a collaborative approach reduces risk of complication, shorten recovery times and improve outcomes This fragmented approach to care is starting to change to a much-needed innovation in hospital design by set up including all the equipment needed for diagnostic imaging, minimally invasive procedures, and traditional surgery, the key requirement is productive collaboration of heart team comprising heart surgeons, interventional cardiologists, and other specialists by working together in the same space, at the same time. Although indications and patient selection of these procedures are still to be defined but high-risk patients have already been shown to benefit from hybrid approaches, In conclusion, HCR is can be used to treat multi-vessel CAD with favourable early results, though growth in the field is limited by surgical experience and success with minimally invasive techniques, should be performed in high volume centers.

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3D Printing—A Cutting Edge Technology for Treating Post-Infarction Patients

Life ◽

10.3390/life11090910 ◽

2021 ◽

Vol 11 (9) ◽

pp. 910

Author(s):

Daniel Cernica ◽

Imre Benedek ◽

Stefania Polexa ◽

Cosmin Tolescu ◽

Theodora Benedek

Keyword(s):

3D Printing ◽

Heart Diseases ◽

Scientific Evidence ◽

Interventional Cardiology ◽

3D Models ◽

Clinical Applications ◽

Patient Specific ◽

Interventional Treatment ◽

Printing Technology ◽

Surgery Patient

The increasing complexity of cardiovascular interventions requires advanced peri-procedural imaging and tailored treatment. Three-dimensional printing technology represents one of the most significant advances in the field of cardiac imaging, interventional cardiology or cardiovascular surgery. Patient-specific models may provide substantial information on intervention planning in complex cardiovascular diseases, and volumetric medical imaging from CT or MRI can be translated into patient-specific 3D models using advanced post-processing applications. 3D printing and additive manufacturing have a great variety of clinical applications targeting anatomy, implants and devices, assisting optimal interventional treatment and post-interventional evaluation. Although the 3D printing technology still lacks scientific evidence, its benefits have been shown in structural heart diseases as well as for treatment of complex arrhythmias and corrective surgery interventions. Recent development has enabled transformation of conventional 3D printing into complex 3D functional living tissues contributing to regenerative medicine through engineered bionic materials such hydrogels, cell suspensions or matrix components. This review aims to present the most recent clinical applications of 3D printing in cardiovascular medicine, highlighting also the potential for future development of this revolutionary technology in the medical field.

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The diagnostic and prognostic value of systems biology research in major traumatic and thermal injury: a review

Burns & Trauma ◽

10.1186/s41038-016-0059-3 ◽

2016 ◽

Vol 4 ◽

pp. 1-11 ◽

Cited By ~ 16

Author(s):

Jon Hazeldine ◽

Peter Hampson ◽

Janet M. Lord

Keyword(s):

At Risk ◽

Inflammatory Response ◽

Thermal Injury ◽

Adverse Outcome ◽

Patient Specific ◽

Metabolite Level ◽

Good Outcome ◽

Poor Outcome ◽

Early Results ◽

Patients At Risk

Abstract As secondary complications remain a significant cause of morbidity and mortality amongst hospitalised trauma patients, the need to develop novel approaches by which to identify patients at risk of adverse outcome is becoming increasingly important. Centred on the idea that patients who experience “poor” outcome post trauma elicit a response to injury that is distinct from those who experience “good” outcome, tailored therapeutics is an emerging concept aimed at improving current treatment regimens by promoting patient-specific therapies. Making use of recent advancements in the fields of genomics, proteomics and metabolomics, numerous groups have undertaken a systems-based approach to analysing the acute immune and inflammatory response to major traumatic and thermal injury in an attempt to uncover a single or combination of biomarkers that can identify patients at risk of adverse outcome. Early results are encouraging, with all three approaches capable of discriminating patients with “good” outcome from those who develop nosocomial infections, sepsis and multiple organ failure, with differences apparent in blood samples acquired as early as 2 h post injury. In particular, genomic data is proving to be highly informative, identifying patients at risk of “poor” outcome with a higher degree of sensitivity and specificity than statistical models built upon data obtained from existing anatomical and physiological scoring systems. Here, focussing predominantly upon human-based research, we provide an overview of the findings of studies that have investigated the immune and inflammatory response to major traumatic and thermal injury at the genomic, protein and metabolite level, and consider both the diagnostic and prognostic potential of these approaches.

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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