Автор: Edited by Michel R. Labrosse
Описание: Decisions in cardiovascular surgery can be life-and-death decisions and often need to be made fast. This is the realm of evidence-based decision-making algorithms that are updated as practices evolve and new techniques are adopted. These algorithms originate from guidelines and recommendations elaborated after statistical treatment of data collected on whole cohorts of patients. While the decision to put knife to skin may be eminently binary, there are usually multiple ways to do so, and the amount of training of the surgeon and supporting team will heavily influence the patient outcome. Therefore, not only the initial decision needs to be adequate but also both the ensuing plan and implementation must be flawless. Surgical planning, as possibly aided by computer simulations to evaluate different scenarios, is one specific area in which biomedical engineers are increasingly involved, aside from their usual role in the development of new medical devices. Many surgeons have already shown an interest in such contributions.
Still, the questions addressed, along with the pace of investigation in biomedical engineering or basic science laboratories, are quite different from what clinicians may be familiar with. This is because experimental test methods need to be developed and mastered before producing consistent, meaningful data, and more often than not, simulation tools also need to be either developed from scratch or modified from existing computational tools. Computer models always need to be verified (i.e., do they solve the problem right? In other words, are the underlying mathematics and computer science correctly implemented?) Computer models also need to be validated (i.e., do they solve the right problem? In other words, does the idealized problem at hand include enough physical phenomena or is it oversimplified?) Both the verification and validation aspects of simulations are rather well established for biomedical engineering devices, thanks to regulatory compliance and certification procedures. However, they are still open-ended concepts, with no standards to speak of when it comes to cardiovascular modeling, because of, among other things, the complexity of their tissue mechanics.
It is hoped, through the present book, to make communication and understanding easier and more natural between clinicians, basic scientists, and biomedical engineers, by finding common language and letting them tell their side of the story. By taking stock of what is known and what has been achieved so far, one can also better appreciate what remains to be accomplished to further the standard of care.
Unraveling the detailed workings of the cardiovascular system and components is still a high priority in the twenty-first century, motivated not only by mankind's inquisitiveness but also by societal and clinical outlooks. According to the World Health Organization, each year, about a third of all deaths worldwide are due to cardiovascular disease. To put things in perspective, this represents the equivalent of 17 million people or half the population of a country like Canada vanishing each year because of cardiovascular disease. Aside from the obvious human loss the disease represents, its massive financial burden is also ballooning, owing to the aging of the population prevalent in many developing and developed countries.
The basic scientists, biomedical engineers, and clinicians engaged in the fight against cardiovascular disease have not been sitting idle. With recent developments such as fully integrated total artificial hearts and the bioprinting of coronary arteries, it is clear that innovative techniques and potential treatments are entering the fray at a rapid pace. In the last few decades, mechanobiology has emerged as a very promising and ever-expanding field, connecting mechanics to issues at the molecular, cellular, and tissue levels, with important ramifications for cardiovascular disease. With the apparent explosion, mosaic-like, of new highly specialized knowledge, it is timely to take a step back and piece together the larger picture of cardiovascular mechanics. There are multiple and excellent books that address one or a couple of specific topics (e.g., cardiovascular solid mechanics and mechanics of the circulation), but on review, it seemed that a book encompassing most major aspects of cardiovascular mechanics is yet to be written. Even if specialized scientific conferences and meetings strive to become increasingly inclusive, there are still significant divides between researchers in cardiovascular solids and fluids, between cellular biochemists and tissue engineers, and, regrettably, also between clinicians and biomedical engineers. The present book aims to provide the readers, irrespective of their backgrounds, with a comprehensive view that enables them to appraise the most recent developments and applications in cardiovascular mechanics through a presentation of the underlying principles and theories.
The first part of the book, comprising five chapters, introduces some fundamental concepts of modern cardiovascular mechanics. As such, Chapter 1 starts from the general anatomy and physiology of the cardiovascular system. Chapter 2 elaborates on the numerous cell and extracellular matrix interactions and, in so doing, underlines the importance of mechanobiological processes. Continuum mechanics, as it applies to the theoretical study of blood flow, is detailed in Chapter 3, whereas its applications to cardiovascular soft tissues are discussed in a brief ad hoc fashion in relevant chapters. For thorough presentations of continuum mechanics for soft tissues and related principles and mathematics, the reader is referred to the masters (Humphrey, 2013; Holzapfel, 2000; Taber, 2004). Next, Chapters 4 and 5 review the experimental and computational methods used in solid and fluid mechanics, providing a basis for discussion of the strengths and limitations of current experiments and computer simulations.
The second part of the book, in another seven chapters, focuses on specific areas of applications of cardiovascular mechanics. Aortic and arterial mechanics are discussed in detail in Chapter 6; atherosclerosis, the condition that develops when plaque builds up in the walls of the arteries and that underlies many problems related to cardiovascular disease, is reviewed in Chapter 7; blood and microcirculation mechanics are considered in Chapter 8; heart valve mechanics are covered in Chapters 9 and 10; and aging is discussed in Chapter 11. Finally, in Chapter 12, an overview of the native mechanobiology of the cardiovascular system is presented in the context of medical devices and drugs, followed by detailed reviews of specific devices that include both engineering and regulatory requirements.
I am deeply indebted to the contributors of this book. Their enthusiasm and support were second to none, and I simply cannot thank them enough! Lastly, although many eyes have reviewed the book's content, I take full responsibility for any error or omission and warmly welcome the readers' feedback.
- Cardiovascular System: Anatomy and Physiology C. A. Gibbons Kroeker
- Cell and Extracellular Matrix Interactions in a Dynamic Biomechanical Environment: The Aortic Valve as an Illustrative Example A. Y. L. Lam and C. A. Simmons
- Blood Flow Mechanics M. Fenech and L. Haya
- Experimental Methods in Cardiovascular Mechanics M. R. Labrosse and L. Kadem
- Computational Methods in Cardiovascular Mechanics F. Auricchio, M. Conti, A. Lefieux, S. Morganti, A. Reali, G. Rozza, and A. Veneziani
- Aortic and Arterial Mechanics S. Avril
- Atherosclerosis and Mechanical Forces M. Kozakova and C. Palombo
- Red Blood Cell and Platelet Mechanics S. Gekle and M. Bender
- Aortic Valve Mechanics J. Dallard, M. Boodhwani, and M. R. Labrosse
- Mitral Valve Mechanics A. Tran, T. G. Mesana, and V. Chan