Clinical Validation of the PSCOPE Hybrid Model Prediction of Left Ventricular Assist Device Implantation Hemodynamics: Three Patient-Specific Cases

ObjectiveThe Physiology Simulation Coupled Experiment (PSCOPE) is a hybrid modeling framework designed for mechanistic cardiovascular predictive modeling. It couples a physical fluid experiment with a lumped parameter network simulation to replicate the closed-loop feedback between simulated cardiovascular physiology and fluid dynamics in the physical experiment. This study validates PSCOPEs predictions of post-surgical physiology against clinical data in the context of HeartMate 3 left ventricular assist device implantation. MethodsWe designed a protocol to characterize the pre- and post-surgical hemodynamics of three adult HeartMate 3 patients using perioperative clinical measurements acquired from routine intensive care unit monitoring. For each patient, we tuned a lumped parameter network model to match their pre-surgical hemodynamic values, creating a patient-specific simulation of the pre-surgical physiology. The PSCOPE framework then modeled LVAD implantation by coupling these simulations to a physical HeartMate 3 device flow experiment. This hybrid model estimates physiological flow rate and pressure parameters to predict the patients post-surgical hemodynamics. ResultsThe percentage difference between PSCOPE predictions and clinical post-surgical hemodynamics ranged from 0.0% to 44.7% across different hemodynamic parameters in different patients. The predicted cardiac index, mean pulmonary arterial pressure, central venous pressure, and pulmonary arterial wedge pressure together accurately indicated the absence of post-implant right ventricular failure in all patients. ConclusionThis validation study demonstrates the potential of PSCOPE in assisting LVAD patient management. PSCOPE hemodynamic predictions could help clinicians anticipate and manage post-implant outcomes, such as right ventricular failure, thereby improving the efficacy of surgical planning.