Développement d’un dispositif médical implantable d’assistance ventriculaire par compression cardiaque directe : l’exosquelette cardiaque

Abstract : Ventricular assistance is a promising therapeutic pathway for terminal chronic heart failure. Notwithstanding the progress made for the development of aorto-ventricular shunt pump among other things, the difficulties relatives to footprint, power supply and/or blood-device interactions are somehow limiting their clinical applications. Recently, direct cardiac compression (DCC) was suggested as a promising lead to overcome the difficulties mentioned above. In this work, we focused on the design and the feasibility of an implantable and mechanical Direct Cardiac Compression device called: The Cardiac Exosqueleton. Our experimental work used Computer Assisted Design (CAD) and numerical modeling to optimize and predict (i) tissue-device interactions and (ii) pressure generation inside ventricular cavities. Then, a functional prototype was realized by additive manufacturing (titanium, polymer) with the help of modeling data and with respect to the anatomical, mechanical and energetical limitations. Finally, we conducted an evaluation of the ability of our device on both in vitro setup and ex vivo heart. We were able to conceive and validate a numerical model based on finite element techniques. This simple yet robust model allowed us to study (i) the impact of suture fixation of a device at the apex of the heart, (ii) the influence of the direct cardiac compression on intracardiac pressures and (iii) overall and local tissue stress in the myocardium. Our prototype showed promising results concerning (i) the restoration of physiological intraventricular pressures, (ii) a low energy consumption and (iii) a shape that is compatible with the thoracic anatomical constraints. All of these results allow us to envision a total implantation of the cardiac exoskeleton into the patient.
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Theses
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http://docnum.univ-lorraine.fr/ulprive/DDOC_T_2018_0313_CHALON.pdf
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https://hal.univ-lorraine.fr/tel-02130340
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Submitted on : Wednesday, May 15, 2019 - 5:03:54 PM
Last modification on : Friday, May 17, 2019 - 9:26:12 AM

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Antoine Chalon. Développement d’un dispositif médical implantable d’assistance ventriculaire par compression cardiaque directe : l’exosquelette cardiaque. Ingénierie biomédicale. Université de Lorraine, 2018. Français. ⟨NNT : 2018LORR0313⟩. ⟨tel-02130340⟩

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