Patient-Specific Finite Element–Based Analysis of Ventricular Myofiber Stress After Coapsys: Importance of Residual Stress Richard Carrick, BS, Liang.

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Patient-Specific Finite Element–Based Analysis of Ventricular Myofiber Stress After Coapsys: Importance of Residual Stress Richard Carrick, BS, Liang Ge, PhD, Lik Chuan Lee, PhD, Zhihong Zhang, MS, Rakesh Mishra, MD, Leon Axel, MD, PhD, Julius M. Guccione, PhD, Eugene A. Grossi, MD, Mark B. Ratcliffe, MD The Annals of Thoracic Surgery Volume 93, Issue 6, Pages 1964-1971 (June 2012) DOI: 10.1016/j.athoracsur.2012.03.001 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Coapsys device. The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Contoured short-axis cardiac magnetic resonance images (A) before and (B) after surgical implantation of the Coapsys device. The contours from multiple short-axis images covering the left ventricle from apex to base were used to create patient-specific three-dimensional finite element models. The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Two views of the unloaded post-Coapsys finite element model showing (A) the PREOP model and (B) the VIRTUAL-COAPSY:SUBACUTE model showing the double pad side of the device. Infarct regions are colored with red, and the remote regions are colored with green. The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Schematic of finite element (FE) model development. 1 indicates determination of diastolic and systolic material parameters by comparison of experimental and computationally derived end-diastolic and end-systolic volume; 2 indicates the acute mechanical effect of Coapsys (VIRTUAL-COAPSYS:ACUTE); 3 indicates the effect of residual stress, with comparison made between VIRTUAL-COAPSY:SUBACUTE and POSTOP models. (LV = left ventricle; MRI = magnetic resonance images.) The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Left ventricular (LV) end-systolic (ES) and (B) end-diastolic (ED) pressure–volume relationship for all four finite element model simulations. (POSTOP = data from magnetic resonance images taken postoperatively; PREOP = data from magnetic resonance images taken preoperatively.) The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Stroke volume versus left ventricular (LV) end-diastolic (ED) pressure relationship for all four finite element model simulations. (POSTOP = data from magnetic resonance images taken postoperatively; PREOP = data from magnetic resonance images taken preoperatively.) The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Average end-diastolic and end-systolic myofiber stress in infarct and remote left ventricular regions for all four finite element model simulations. (POSTOP = data from magnetic resonance images taken postoperatively; PREOP = data from magnetic resonance images taken preoperatively.) The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Myofiber stress at end-systole in the (A) PREOP model (data from magnetic resonance images taken preoperatively), and in the (B) VIRTUAL-COAPSYS:SUBACUTE model. Units of measurement are kilopascals. The Annals of Thoracic Surgery 2012 93, 1964-1971DOI: (10.1016/j.athoracsur.2012.03.001) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions