Pulmonary arterial hypertension (PAH) is a chronic disease with a high mortality rate mainly related to progressive right ventricular (RV) failure. In patients who deteriorate despite optimal medical therapy, lung transplantation remains the only therapeutic option. However, because of shortage of organ donors, many patients die on the waiting list. RV Assist Devices (RVADs) could reduce hospitalizations for RV failure and bring patient to transplantation. To date, the experience on RVAD in these patients is poor. Simulators with computational models have been pivotal in the development of left ventricular assist devices but haven't allowed the evolution of RVAD. In fact, to date the available models don't overcome the pathophysiological problems of PH, having the following limitations: not calibrated on human data; focus only on RV passive mechanics ignoring active mechanics; don't take into account interventricular interaction, neither coronary circulation nor the ventilator mechanics and don't couple together systemic and pulmonary circulatory systems. Our center has been collaborating in the last years with the National Research Council (CNR) Institute of Clinical physiology, leading to the development of a simulator computational model, CARDIOSIM©.
Our aim is to bring this simulator platform from a TRL 6 to 8, developing a new, robust and innovative computational software able to simulate pathophysiologic behaviors in advanced PAH and to provide important information to improve RVAD development in the near future. The projects will consist of 3 phases: 1)algorithm implementation; 2)data collection of right heart catheterization at rest and after exercise, cardiac magnetic resonance and cardiopulmonary test from a derivation cohort from our center in Policlinico Umberto I using them to train the simulator; 3) software validation using data of the cohorts from Arizona College of Medicine and Ohio centers State University Wexner Medical Center.
