Cardiovascular biomechanics and implantable medical devices

Cardiovascular disease is one of the leading causes of death in industrialized countries. However, recent advances in medical imaging, digital simulation, biomaterials and biomechanics are paving the way for remarkable improvements in patient screening and treatment, putting engineering at the heart of decision-making in vascular and cardiac medicine and surgery.

This article focuses on the major advances in cardiovascular biomechanics and implantable biomaterials in this field. The article covers both circulatory biomechanics (the science of blood flow in vessels, using the tools and formalism of fluid mechanics) and parietal biomechanics (the science of mechanical deformations and stresses in blood vessels and the heart, using the tools and formalism of the mechanics of deformable solids). The article also briefly presents the medical devices and biomaterials used in the treatment of certain cardiovascular diseases manifested by biomechanical failures. The market for these medical devices is gigantic, representing several billion dollars worldwide for aortic aneurysms alone.

This article is organized into four parts. The first part is dedicated to circulatory biomechanics and hemodynamics, successively addressing the organization of blood circulation and its role, blood pressure regulation, the pulse wave, blood rheology and numerical models in hemodynamics. The second part deals with parietal biomechanics, including the structure and functional characteristics of blood vessels and the heart, the elastic properties of vessels, their mechanical resistance, and changes in these properties during growth and remodeling. The third part presents four main cardiovascular pathologies that are the subject of biomechanical studies to improve their medical management: hypertension, atherosclerosis, cerebral aneurysms and aortic aneurysms. The fourth part is devoted to implantable medical devices in contact with blood.

This article summarizes several reference works covering different topics that are usually treated separately, but are grouped together here, such as circulatory biomechanics, venous hemodynamics, arterial wall biomechanics, cardiac biomechanics and implantable medical devices. The presentation is not exhaustive, but covers the areas where research efforts are currently most significant.

The main aim of this article is to present the scientific basis for understanding tomorrow's challenges in cardiovascular biomechanics: individualized prediction of the risk of cardiovascular accidents, digital tools to aid surgical decision-making, new regenerative therapies... The article is accessible to a wide readership. More in-depth knowledge of fluid mechanics, solid mechanics and biology will be required for the lay...