The Role of Simulation for Preoperative Planning in Patients Requiring Mechanical Circulatory Support

Mathematical modelling and simulation have the potential to become clinically applicable tools for detailed evaluation of the cardiovascular system and clinical decision-making to guide therapeutic intervention. This approach has a great potential for application in heart failure where the impact of left ventricular assist devices (LVADs) has played a significant role as a bridge to transplant and more recently as a long-term solution for non eligible candidates. We sought to investigate the value of simulation in the context of a heart failure patient with a view to predict or guide further management. CARDIOSIM© software was used to find out the most appropriate course of action to apply in this clinical setting. The outcome of the simulation was compared with the decision previously made in the clinical environment. Although there was an encouraging agreement, other factors play a role in the clinical decision process. Patient-specific modelling may add a more quantitative approach but requires willingness to accept a different way of thinking.