Decision-making in advanced heart failure patients requiring LVAD insertion: can preoperative simulation become the way forward? A case study

Clinical practice heavily relies on results from randomized controlled trials, which may not reflect completely individual patients. Patient-specific modelling has received increasing attention in recent years. Although still far from clinical application on a daily basis, the potential of this approach is significant. The treatment of advanced heart failure may benefit from a modelling framework to guide device treatment and predict outcome. The role of mechanical circulatory support as a long-term solution is increasing in view of the evolving technology and worsening heart failure patient population. Therefore, a preoperative strategy with the ability to predict the course of events in a simulation setting may be justified. Here we present a heart failure patient discussed at a multidisciplinary team meeting whose outcome was compared with simulations carried out with CARDIOSIM© software to investigate the role of this approach as a planning strategy to guide intervention and predict outcome. The clinical decision process is complex and many factors are involved. Patient-specific modelling may have a role to play as part of a preoperative planning strategy with more quantitative evaluation to smooth decision-making.