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Ventre J, Politi MT, Fernández JM, Ghigo AR, Gaudric J, Wray SA, Lagaert JB, Armentano R, Capurro C, Fullana JM, Lagrée PY. Parameter estimation to study the immediate impact of aortic cross-clamping using reduced order models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3261. [PMID: 31617333 DOI: 10.1002/cnm.3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
Aortic cross-clamping is a common strategy during vascular surgery, however, its instantaneous impact on hemodynamics is unknown. We, therefore, developed two numerical models to estimate the immediate impact of aortic clamping on the vascular properties. To assess the validity of the models, we recorded continuous invasive pressure signals during abdominal aneurysm repair surgery, immediately before and after clamping. The first model is a zero-dimensional (0D) three-element Windkessel model, which we coupled to a gradient-based parameter estimation algorithm to identify patient-specific parameters such as vascular resistance and compliance. We found a 10% increase in the total resistance and a 20% decrease in the total compliance after clamping. The second model is a nine-artery network corresponding to an average human body in which we solved the one-dimensional (1D) blood flow equations. With a similar parameter estimation method and using the results from the 0D model, we identified the resistance boundary conditions of the 1D network. Determining the patient-specific total resistance and the distribution of peripheral resistances through the parameter estimation process was sufficient for the 1D model to accurately reproduce the impact of clamping on the pressure waveform. Both models gave an accurate description of the pressure wave and had a high correlation (R2 > .95) with experimental blood pressure data.
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Affiliation(s)
- Jeanne Ventre
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
| | - M Teresa Politi
- Universidad de Buenos Aires, Facultad de Medicina. Departamento de Ciencias Fisiológicas, Laboratorio de Biomembranas, Buenos Aires, Argentina
- CONICET-Universidad de Buenos Aires, Instituto de Fisiologíay Biofísica "Bernardo Houssay", Buenos Aires, Argentina
| | - Juan M Fernández
- Universidad de Buenos Aires, Facultad de Medicina. Departamento de Ciencias Fisiológicas, Laboratorio de Biomembranas, Buenos Aires, Argentina
- CONICET-Universidad de Buenos Aires, Instituto de Fisiologíay Biofísica "Bernardo Houssay", Buenos Aires, Argentina
| | - Arthur R Ghigo
- Institut de Mécanique des Fluides de Toulouse (IMFT), Université de Toulouse, CNRS, INPT, UPS
| | - Julien Gaudric
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
- Service de Chirurgie Vasculaire, Hôpitaux Universitaires La Pitié-Salpêtriêre, Paris, France
| | - Sandra A Wray
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | | | - Ricardo Armentano
- Departamento de Ingeniería Biológica, Universidad de la República, Montevideo, Uruguay
| | - Claudia Capurro
- Universidad de Buenos Aires, Facultad de Medicina. Departamento de Ciencias Fisiológicas, Laboratorio de Biomembranas, Buenos Aires, Argentina
- CONICET-Universidad de Buenos Aires, Instituto de Fisiologíay Biofísica "Bernardo Houssay", Buenos Aires, Argentina
| | - José Maria Fullana
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
| | - Pierre-Yves Lagrée
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
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Politi MT, Ventre J, Fernández JM, Ghigo A, Gaudric J, Armentano R, Capurro C, Lagrée PY. Effects of Cross-Clamping on Vascular Mechanics: Comparing Waveform Analysis With a Numerical Model. J Surg Res 2019; 244:587-598. [PMID: 31521941 DOI: 10.1016/j.jss.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immediate changes in vascular mechanics during aortic cross-clamping remain widely unknown. By using a numerical model of the arterial network, vascular compliance and resistance can be estimated and the time constant of pressure waves can be calculated and compared with results from the classic arterial waveform analysis. METHODS Experimental data were registered from continuous invasive radial artery pressure measurements from 11 patients undergoing vascular surgery. A stable set of beats were chosen immediately before and after each clamping event. Through the arterial waveform analysis, the time constant was calculated for each individual beat and for a mean beat of each condition as to compare with numerical simulations. Overall proportional changes in resistance and compliance during clamping and unclamping were calculated using the numerical model. RESULTS Arterial waveform analysis of individual beats indicated a significant 10% median reduction in the time constant after clamping, and a significant 17% median increase in the time constant after unclamping. There was a positive correlation between waveform analysis and numerical values of the time constant, which was moderate (ρ = 0.51; P = 0.01486) during clamping and strong (ρ = 0.77; P ≤ 0.0001) during unclamping. After clamping, there was a significant 16% increase in the mean resistance and a significant 23% decrease in the mean compliance. After unclamping, there was a significant 19% decrease in the mean resistance and a significant 56% increase in the mean compliance. CONCLUSIONS There are significant hemodynamic changes in vascular compliance and resistance during aortic clamping and unclamping. Numerical computer models can add information on the mechanisms of injury due to aortic clamping.
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Affiliation(s)
- María Teresa Politi
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Fisiología y Biofísica Bernardo Houssay, Buenos Aires, Argentina.
| | - Jeanne Ventre
- Sorbonne Université, Institut Jean Le Rond d'Alembert, CNRS, Paris, France
| | - Juan Manuel Fernández
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Fisiología y Biofísica Bernardo Houssay, Buenos Aires, Argentina
| | - Arthur Ghigo
- Université de Toulouse, Institut de Mécanique des Fluides de Toulouse (IMFT). CNRS, INPT, UPS, Toulouse, France
| | - Julien Gaudric
- Sorbonne Université, Institut Jean Le Rond d'Alembert, CNRS, Paris, France; Hôpitaux Universitaires La Pitié-Salpêtrière, Service de Chirurgie Vasculaire, Paris, France
| | - Ricardo Armentano
- Departamento de Ingeniería Mecánica, Universidad de Buenos Aires, Facultad de Ingeniería, Buenos Aires, Argentina
| | - Claudia Capurro
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Fisiología y Biofísica Bernardo Houssay, Buenos Aires, Argentina
| | - Pierre-Yves Lagrée
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; Sorbonne Université, Institut Jean Le Rond d'Alembert, CNRS, Paris, France
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Zammert M, Gelman S. The pathophysiology of aortic cross-clamping. Best Pract Res Clin Anaesthesiol 2016; 30:257-69. [PMID: 27650338 DOI: 10.1016/j.bpa.2016.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022]
Abstract
During open aortic surgery, interrupting the blood flow through the aorta by applying a cross-clamp is often a key step to allow for surgical repair. As a consequence, ischemia is induced in parts of the body distal to the clamp site. This significant alteration in the blood flow is almost always associated with hemodynamic changes. Upon release of the cross-clamp, the blood flow is restored, triggering an ischemia-reperfusion response, leading to many pathophysiological processes such as inflammation, humoral changes, and metabolite circulation that could lead to injury in many organ systems and may significantly influence the postoperative outcome. It is therefore important to understand these processes and how they can be treated in order to allow for safe surgical aortic repairs while ensuring the best possible outcomes.
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Affiliation(s)
- Martin Zammert
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Simon Gelman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Ouattara A, Dewitte A, Rozé H. Intraoperative management of heart-lung interactions: "from hypothetical prediction to improved titration". ACTA ACUST UNITED AC 2014; 33:476-9. [PMID: 25127853 DOI: 10.1016/j.annfar.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extensive literature describes the suitability of dynamic parameters to predict responsiveness in fluid. However, based on heart-lung interactions, these parameters can have serious limitations, including the use of protective lung ventilation. Although the latter seems to be beneficial for healthy patients undergoing high-risk surgery, the intraoperative interpretation of dynamic parameters to predict fluid responsiveness can be hazardous. In this context, the attending physician could, alternatively, titrate the need of fluids with a small fluid challenge, which remains unaffected by low tidal volume, the presence of arrhythmia, or the presence of spontaneous ventilation. When intraoperative prediction of fluid responsiveness is required in mechanically ventilated patients, "improved" titration should be preferred to a hypothetical prediction.
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Affiliation(s)
- A Ouattara
- Université de Bordeaux, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Inserm, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Service d'anesthésie-réanimation II, maison du Haut-Lévêque, groupe hospitalier Sud, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - A Dewitte
- Université de Bordeaux, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Service d'anesthésie-réanimation II, maison du Haut-Lévêque, groupe hospitalier Sud, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, bioingénierie tissulaire, U1026, 33000 Bordeaux, France
| | - H Rozé
- Université de Bordeaux, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Inserm, adaptation cardiovasculaire à l'ischémie, U1034, 33600 Pessac, France; Service d'anesthésie-réanimation II, maison du Haut-Lévêque, groupe hospitalier Sud, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France
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