1
|
Zambrano BA, Wilson SI, Zook S, Vekaria B, Moreno MR, Kassi M. Computational investigation of outflow graft variation impact on hemocompatibility profile in LVADs. Artif Organs 2024; 48:375-385. [PMID: 37962282 DOI: 10.1111/aor.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Hemocompatibility-related adverse events (HRAE) occur commonly in patients with left ventricular assist devices (LVADs) and add to morbidity and mortality. It is unclear whether the outflow graft orientation can impact flow conditions leading to HRAE. This study presents a simulation-based approach using exact patient anatomy from medical images to investigate the influence of outflow cannula orientation in modulating flow conditions leading to HRAEs. METHODS A 3D model of a proximal aorta and outflow graft was reconstructed from a computed tomography (CT) scan of an LVAD patient and virtually modified to model multiple cannula orientations (n = 10) by varying polar (cranio-caudal) (n = 5) and off-set (anterior-posterior) (n = 2) angles. Time-dependent computational flow simulations were then performed for each anatomical orientation. Qualitative and quantitative hemodynamics metrics of thrombogenicity including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), endothelial cell platelet activation potential (ECAP), particle residence time (PRT), and platelet activation potential (PLAP) were analyzed. RESULTS Within the simulations performed, endothelial cell activation potential (ECAP) and particle residence time (PRT) were found to be lowest with a polar angle of 85°, regardless of offset angle. However, polar angles that produced parameters at levels least associated with thrombosis varied when the offset angle was changed from 0° to 12°. For offset angles of 0° and 12° respectively, flow shear was lowest at 65° and 75°, time averaged wall shear stress (TAWSS) was highest at 85° and 35°, and platelet activation potential (PLAP) was lowest at 65° and 45°. CONCLUSION This study suggests that computational fluid dynamic modeling based on patient-specific anatomy can be a powerful analytical tool when identifying optimal positioning of an LVAD. Contrary to previous work, our findings suggest that there may be an "ideal" outflow cannula for each individual patient based on a CFD-based hemocompatibility profile.
Collapse
Affiliation(s)
- Byron A Zambrano
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Shannon I Wilson
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Salma Zook
- Houston Methodist, Department of Cardiology, Houston Methodist Research Hospital, Houston, Texas, USA
| | - Bansi Vekaria
- Houston Methodist, Department of Cardiology, Houston Methodist Research Hospital, Houston, Texas, USA
| | - Michael R Moreno
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Mahwash Kassi
- Houston Methodist, Department of Cardiology, Houston Methodist Research Hospital, Houston, Texas, USA
| |
Collapse
|
2
|
Li S, Jin D, Gui X. Dynamic characteristic modeling of left ventricular assist devices based on hysteresis effects. Comput Biol Med 2023; 157:106737. [PMID: 36921456 DOI: 10.1016/j.compbiomed.2023.106737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/24/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study is to develop a new model for the dynamic characteristics of left ventricular assist devices (LVADs) interacting with the cardiovascular system under constant-speed modes. METHODS A new hysteresis model is established on the basis of the hysteresis effect and turbomachinery principles. The simulation results from the hysteresis model were compared with the inertia model. The in-vitro experiment results of a centrifugal pump (from literature) and the unsteady computational fluid dynamics (CFD) simulation results of an axial pump were used as the benchmarks. RESULTS Compared with the inertia model, at the partial support mode, the relative estimation error of the time to the maximum and minimum pump flow (Q) in the hysteresis model decreased at least 16.3% cardiac cycle (Tc) in the centrifugal pump and at least 1.9% Tc in the axial pump, indicating its ability to simulate more realistic Q fluctuations. Moreover, the hysteresis model could predict an accurate time distribution of different Q. CONCLUSION The hysteresis model provides a general calculation method for simulating the dynamic characteristics of constant-speed LVADs under interaction with the cardiovascular system. It is more accurate than the inertia model. SIGNIFICANCE The hysteresis model is helpful for the rapid estimation of unsteady dynamic characteristics in absence of a physical pump prototype at the preliminary design stage.
Collapse
Affiliation(s)
- Shulei Li
- School of Energy and Power Engineering, Beihang University, Beijing, PR China
| | - Donghai Jin
- School of Energy and Power Engineering, Beihang University, Beijing, PR China.
| | - Xingmin Gui
- School of Energy and Power Engineering, Beihang University, Beijing, PR China
| |
Collapse
|
3
|
Yuan HW, Yao JX, Huang SY, Cui MY, Ji RJ, Li JR, Chen LH. Asymmetric distribution of pathogenic low wall shear stress of the bilateral subclavian arteries: two case reports. J Int Med Res 2021; 49:3000605211042503. [PMID: 34515575 PMCID: PMC8442501 DOI: 10.1177/03000605211042503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The effects of increasing blood flow on the pathogenic wall shear stress (pWSS)
of subclavian arteries (SAs) are currently unclear. Patient-specific models of
the SA were constructed based on computed tomographic images from two patients.
Using the Ansys Fluent 19.0 transient laminar flow solver, the finite volume
method was chosen to solve the Navier–Stokes equation governing fluid behavior.
The time-averaged wall shear stress, ratio of risk area, cumulative ratio of
risk area (P¯), ratio of risk time, and ratio contour of risk time were
calculated to describe the temporal and spatial distributions of pWSS. Virtually
all pWSS occurred during the diastolic phase. The P¯ was 2.3 and 1.29 times higher on the left than on the right
in Patients 1 (P1) and 2 (P2), respectively. Increasing the blood flow volume of
the left SA by 20%, 40%, and 60% led to a 9.27%, 15.10%, and 20.99% decrease
in P¯ for P1 and a 5.74%, 11.55%, and 17.14% decrease in
P¯ for P2, respectively, compared with baseline values. In
conclusion, the left SA showed greater diastolic pWSS than the right SA, and
increasing the blood flow volume reduced the pWSS in the left SA.
Collapse
Affiliation(s)
- Huai Wu Yuan
- Department of Neurology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jin Xun Yao
- College of Aeronautics and Astronautics, 12377Zhejiang University, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Si Yu Huang
- Department of Neurology, Shengzhou People's Hospital, Shengzhou, Zhejiang Province, China
| | - Min Yong Cui
- Department of Ultrasonography, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ren Jie Ji
- Department of Neurology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jia Rui Li
- Department of Neurology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Li Hua Chen
- College of Aeronautics and Astronautics, 12377Zhejiang University, Zhejiang University, Hangzhou, Zhejiang Province, China
| |
Collapse
|
4
|
Neidlin M, Liao S, Li Z, Simpson B, Kaye DM, Steinseifer U, Gregory S. Understanding the influence of left ventricular assist device inflow cannula alignment and the risk of intraventricular thrombosis. Biomed Eng Online 2021; 20:47. [PMID: 33975591 PMCID: PMC8114696 DOI: 10.1186/s12938-021-00884-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Adverse neurological events associated with left ventricular assist devices (LVADs) have been suspected to be related to thrombosis. This study aimed to understand the risks of thrombosis with variations in the implanted device orientation. A severely dilated pulsatile patient-specific left ventricle, modelled with computational fluid dynamics, was utilised to identify the risk of thrombosis for five cannulation angles. With respect to the inflow cannula axis directed towards the mitral valve, the other angles were 25° and 20° towards the septum and 20° and 30° towards the free wall. Results Inflow cannula angulation towards the free wall resulted in longer blood residence time within the ventricle, slower ventricular washout and reduced pulsatility indices along the septal wall. Based on the model, the ideal inflow cannula alignment to reduce the risk of thrombosis was angulation towards the mitral valve and up to parallel to the septum, avoiding the premature clearance of incoming blood. Conclusions This study indicates the potential effects of inflow cannulation angles and may guide optimised implantation configurations; however, the ideal approach will be influenced by other patient factors and is suspected to change over the course of support. Supplementary Information The online version contains supplementary material available at 10.1186/s12938-021-00884-6.
Collapse
Affiliation(s)
- Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany.
| | - Sam Liao
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany.,Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia.,Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - Zhiyong Li
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - Benjamin Simpson
- Department of Engineering, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - David M Kaye
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany.,Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia
| | - Shaun Gregory
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia.,Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| |
Collapse
|
5
|
Sun P, Bozkurt S, Sorguven E. Computational analyses of aortic blood flow under varying speed CF-LVAD support. Comput Biol Med 2020; 127:104058. [PMID: 33091606 DOI: 10.1016/j.compbiomed.2020.104058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
Continuous Flow Left Ventricular Assist Devices (CF-LVADs) generally operate at a constant speed whilst supporting a failing heart. However, constant speed CF-LVAD support may cause complications and increase the morbidity rates in the patients. Therefore, different varying speed operating modes for CF-LVADs have been proposed to generate more physiological blood flow, which may reduce complication rates under constant speed CF-LVAD support. The proposed varying speed CF-LVAD algorithms simulate time-dependant dynamics and three dimensional blood flow patterns in aorta under varying speed CF-LVAD support remain unclear. The aim of this study is to evaluate three dimensional blood flow patterns in a patient-specific aorta model under co-pulsating and counter-pulsating CF-LVAD support modes driven by speed and flow rate control algorithms using numerical simulations. Aortic blood flow was evaluated for 10,000 rpm constant speed CF-LVAD support generating 4.71 L/min mean flow rate over a cardiac cycle. Co-pulsating and counter-pulsating CF-LVAD speed control operated the pump at the same average speed over a cardiac cycle and co-pulsating and counter-pulsating CF-LVAD flow rate control generated the same average flow rate over cardiac cycle as in the constant speed pump support. Simulation results show that the utilised counter-pulsating pump flow rate control may decrease the haemolysis to a third compared to the most commonly employed constant speed pump operating mode. Moreover, CF-LVAD support utilising counter-pulsating pump flow rate control generated the most favourable hemodynamic characteristics, i.e. low Dean number, least wall shear stress and least haemolysis values among the investigated cases.
Collapse
Affiliation(s)
- Peiying Sun
- Thermo Fluid Mechanics Research Centre (TFMRC), University of Sussex, Falmer, BN1 9RS, UK
| | - Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Esra Sorguven
- Thermo Fluid Mechanics Research Centre (TFMRC), University of Sussex, Falmer, BN1 9RS, UK.
| |
Collapse
|
6
|
Gallo M, Spigolon L, Bejko J, Gerosa G, Bottio T. How to evaluate the outflow tract of LVAD after minimally invasive implantation by 3D CT-scan. Artif Organs 2020; 44:1306-1309. [PMID: 32668042 DOI: 10.1111/aor.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 12/27/2022]
Abstract
During a minimally invasive implantation technique, the outflow graft of left ventricular assist device (LVAD) is tunnelled blindly through the pericardium or left pleura, with an inability to assess for twisting or malposition. Three-dimensional computed tomography scan (CT-scan) has a role in qualitative evaluation of the different outflow tract configurations. The different surgical minimally invasive approaches include: (a) mini-sternotomy and left mini-thoracotomy, (b) right mini-thoracotomy and left mini-thoracotomy, (c) subclavian artery access and left mini-thoracotomy. The outflow graft could be anastomosed to the left axillary artery or the ascending aorta. CT-scan reconstruction using syngo InSpace4D (Siemens, Muenchen, Germany) was used to provide fast segmentation and high-resolution images. The 3D reconstructions permit an evaluation of different anastomosis configurations and to assess the route of outflow graft.
Collapse
Affiliation(s)
- Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland.,Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Luca Spigolon
- Division of Radiology, Vicenza Hospital, Vicenza, Italy
| | - Jonida Bejko
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Tomaso Bottio
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| |
Collapse
|
7
|
Yoshida S, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kainuma S, Kawamura T, Kawamura A, Nakatani S, Sawa Y. Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous‐flow left ventricular‐assist device support. Artif Organs 2020; 44:883-891. [DOI: 10.1111/aor.13671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | - Koichi Toda
- Cardiovascular Surgery Osaka University Suita Japan
| | | | | | - Hiroki Hata
- Cardiovascular Surgery Osaka University Suita Japan
| | | | | | | | - Ai Kawamura
- Cardiovascular Surgery Osaka University Suita Japan
| | | | - Yoshiki Sawa
- Cardiovascular Surgery Osaka University Suita Japan
| |
Collapse
|
8
|
Virtual Fitting and Hemodynamic Simulation of the EVAHEART 2 Left Ventricular Assist Device and Double-Cuff Tipless Inflow Cannula. ASAIO J 2019; 65:698-706. [DOI: 10.1097/mat.0000000000000867] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
9
|
Left Ventricular Assist Device Inflow Cannula Insertion Depth Influences Thrombosis Risk. ASAIO J 2019; 66:766-773. [DOI: 10.1097/mat.0000000000001068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
10
|
Boes S, Thamsen B, Haas M, Daners MS, Meboldt M, Granegger M. Hydraulic Characterization of Implantable Rotary Blood Pumps. IEEE Trans Biomed Eng 2019; 66:1618-1627. [DOI: 10.1109/tbme.2018.2876840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
11
|
Thaker R, Araujo-Gutierrez R, Marcos-Abdala HG, Agrawal T, Fida N, Kassi M. Innovative Modeling Techniques and 3D Printing in Patients with Left Ventricular Assist Devices: A Bridge from Bench to Clinical Practice. J Clin Med 2019; 8:E635. [PMID: 31075841 PMCID: PMC6572374 DOI: 10.3390/jcm8050635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/24/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
Left ventricular assist devices (LVAD) cause altered flow dynamics that may result in complications such as stroke, pump thrombosis, bleeding, or aortic regurgitation. Understanding altered flow dynamics is important in order to develop more efficient and durable pump configurations. In patients with LVAD, hemodynamic assessment is limited to imaging techniques such as echocardiography which precludes detailed assessment of fluid dynamics. In this review article, we present some innovative modeling techniques that are often used in device development or for research purposes, but have not been utilized clinically. Computational fluid dynamic (CFD) modeling is based on computer simulations and particle image velocimetry (PIV) employs ex vivo models that helps study fluid characteristics such as pressure, shear stress, and velocity. Both techniques may help elaborate our understanding of complications that occur with LVAD and could be potentially used in the future to troubleshoot LVAD-related alarms. These techniques coupled with 3D printing may also allow for patient-specific device implants, lowering the risk of complications increasing device durability.
Collapse
Affiliation(s)
- Rishi Thaker
- Touro College of Osteopathic Medicine, Middletown, New York, NY 10940, USA.
| | - Raquel Araujo-Gutierrez
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA.
| | - Hernan G Marcos-Abdala
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA.
| | - Tanushree Agrawal
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA.
| | - Nadia Fida
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA.
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA.
| |
Collapse
|
12
|
Leguy C. Mathematical and Computational Modelling of Blood Pressure and Flow. SERIES IN BIOENGINEERING 2019. [DOI: 10.1007/978-981-10-5092-3_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
13
|
Selmi M, Chiu WC, Chivukula VK, Melisurgo G, Beckman JA, Mahr C, Aliseda A, Votta E, Redaelli A, Slepian MJ, Bluestein D, Pappalardo F, Consolo F. Blood damage in Left Ventricular Assist Devices: Pump thrombosis or system thrombosis? Int J Artif Organs 2018; 42:113-124. [PMID: 30354870 DOI: 10.1177/0391398818806162] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Despite significant technical advancements in the design and manufacture of Left Ventricular Assist Devices, post-implant thrombotic and thromboembolic complications continue to affect long-term outcomes. Previous efforts, aimed at optimizing pump design as a means of reducing supraphysiologic shear stresses generated within the pump and associated prothrombotic shear-mediated platelet injury, have only partially altered the device hemocompatibility. Methods: We examined hemodynamic mechanisms that synergize with hypershear within the pump to contribute to the thrombogenic potential of the overall Left Ventricular Assist Device system. Results: Numerical simulations of blood flow in differing regions of the Left Ventricular Assist Device system, that is the diseased native left ventricle, the pump inflow cannula, the impeller, the outflow graft and the anastomosed downstream aorta, reveal that prothrombotic hemodynamic conditions might occur at these specific sites. Furthermore, we show that beyond hypershear, additional hemodynamic abnormalities exist within the pump, which may elicit platelet activation, such as recirculation zones and stagnant platelet trajectories. We also provide evidences that particular Left Ventricular Assist Device implantation configurations and specific post-implant patient management strategies, such as those allowing aortic valve opening, are more hemodynamically favorable and reduce the thrombotic risk. Conclusion: We extend the perspective of pump thrombosis secondary to the supraphysiologic shear stress environment of the pump to one of Left Ventricular Assist Device system thrombosis, raising the importance of comprehensive characterization of the different prothrombotic risk factors of the total system as the target to achieve enhanced hemocompatibility and improved clinical outcomes.
Collapse
Affiliation(s)
- Matteo Selmi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- Department of Surgery, Division of Cardiac Surgery, Università di Verona, Verona, Italy
| | - Wei-Che Chiu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | | | - Giulio Melisurgo
- Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Marvin J Slepian
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
- Departments of Medicine and Biomedical Engineering, The University of Arizona, Tucson, AZ, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Federico Pappalardo
- Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milano, Italy
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milano, Italy
- Università Vita-Salute San Raffaele, Milano, Italy
| | - Filippo Consolo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milano, Italy
- Università Vita-Salute San Raffaele, Milano, Italy
| |
Collapse
|
14
|
Liao S, Neidlin M, Li Z, Simpson B, Gregory SD. Ventricular flow dynamics with varying LVAD inflow cannula lengths: In-silico evaluation in a multiscale model. J Biomech 2018; 72:106-115. [PMID: 29567308 DOI: 10.1016/j.jbiomech.2018.02.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/14/2018] [Accepted: 02/28/2018] [Indexed: 01/17/2023]
Abstract
Left ventricular assist devices are associated with thromboembolic events, which are potentially caused by altered intraventricular flow. Due to patient variability, differences in apical wall thickness affects cannula insertion lengths, potentially promoting unfavourable intraventricular flow patterns which are thought to be correlated to the risk of thrombosis. This study aimed to present a 3D multiscale computational fluid dynamic model of the left ventricle (LV) developed using a commercial software, Ansys, and evaluate the risk of thrombosis with varying inflow cannula insertion lengths in a severely dilated LV. Based on a HeartWare HVAD inflow cannula, insertion lengths of 5, 19, 24 and 50 mm represented cases of apical hypertrophy, typical ranges of apical thicknesses and an experimental length, respectively. The risk of thrombosis was evaluated based on blood washout, residence time, instantaneous blood stagnation and a pulsatility index. By introducing fresh blood to displace pre-existing blood in the LV, after 5 cardiac cycles, 46.7%, 45.7%, 45.1% and 41.8% of pre-existing blood remained for insertion lengths of 5, 19, 24 and 50 mm, respectively. Compared to the 50 mm insertion, blood residence time was at least 9%, 7% and 6% higher with the 5, 19 and 24 mm insertion lengths, respectively. No instantaneous stagnation at the apex was observed directly after the E-wave. Pulsatility indices adjacent to the cannula increased with shorter insertion lengths. For the specific scenario studied, a longer insertion length, relative to LV size, may be advantageous to minimise thrombosis by increasing LV washout and reducing blood residence time.
Collapse
Affiliation(s)
- Sam Liao
- Queensland University of Technology (QUT), Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, QLD 4059, Australia; Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032, Australia; Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany.
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Zhiyong Li
- Queensland University of Technology (QUT), Institute of Health and Biomedical Innovation (IHBI), Kelvin Grove, QLD 4059, Australia
| | - Benjamin Simpson
- Department of Engineering, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, United Kingdom
| | - Shaun D Gregory
- Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032, Australia; School of Engineering, Griffith University, Southport, QLD 4215, Australia
| |
Collapse
|
15
|
Imamura T, Adatya S, Chung B, Nguyen A, Rodgers D, Sayer G, Sarswat N, Kim G, Raikhelkar J, Ota T, Song T, Juricek C, Medvedofsky D, Jeevanandam V, Lang R, Estep JD, Burkhoff D, Uriel N. Cannula and Pump Positions Are Associated With Left Ventricular Unloading and Clinical Outcome in Patients With HeartWare Left Ventricular Assist Device. J Card Fail 2017; 24:159-166. [PMID: 28982636 DOI: 10.1016/j.cardfail.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/10/2017] [Accepted: 09/25/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cannula and pump positions are associated with clinical outcomes such as device thrombosis in patients with HeartMate II; however, clinical implications of HVAD (HeartWare International, Framingham, Massachusetts) cannula position are unknown. This study aims to assess the relationship among cannula position, left ventricular (LV) unloading, and patient prognosis. METHODS AND RESULTS Twenty-seven HVAD patients (60.0 ± 12.6 years of age and 19 males [70%]) underwent ramp test. Device position was quantified from chest X-ray parameters obtained at the time of the hemodyamic ramp test: (1) cannula coronal angle, (2) pump depth, (3) cannula sagittal angle, and (4) pump area. Lower cannula coronal angle was associated with LV unloading (as measured by smaller LV diastolic dimension and lower pulmonary capillary wedge pressure). Smaller pump area was associated with LV dynamic unloading, as assessed by steeper negative slopes of LV diastolic dimension and pulmonary capillary wedge pressure during incremental rotational speed change. Cannula coronal angle ≤65° was associated with reduced heart failure readmission rate (hazard ratio, 10.33; P = .007 by log-rank test). CONCLUSION HVAD cannula and pump positions are associated with LV unloading and improved clinical outcomes. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on clinical outcomes are warranted.
Collapse
Affiliation(s)
- Teruhiko Imamura
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Sirtaz Adatya
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ben Chung
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ann Nguyen
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Daniel Rodgers
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Gabriel Sayer
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Nitasha Sarswat
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Jayant Raikhelkar
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Tae Song
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Colleen Juricek
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Diego Medvedofsky
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - Roberto Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - Daniel Burkhoff
- Columbia University Medical Center, and Cardiovascular Research Foundation, New York, New York
| | - Nir Uriel
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
| |
Collapse
|
16
|
Particle image velocimetry study of the celiac trunk hemodynamic induced by continuous-flow left ventricular assist device. Med Eng Phys 2017; 47:47-54. [DOI: 10.1016/j.medengphy.2017.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/05/2017] [Accepted: 06/14/2017] [Indexed: 01/17/2023]
|
17
|
Scardulla F, Pasta S, D’Acquisto L, Sciacca S, Agnese V, Vergara C, Quarteroni A, Clemenza F, Bellavia D, Pilato M. Shear stress alterations in the celiac trunk of patients with a continuous-flow left ventricular assist device as shown by in-silico and in-vitro flow analyses. J Heart Lung Transplant 2017; 36:906-913. [DOI: 10.1016/j.healun.2017.03.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/17/2017] [Accepted: 03/22/2017] [Indexed: 11/27/2022] Open
|
18
|
Schmidt T, Rosenthal D, Reinhartz O, Riemer K, He F, Hsia TY, Marsden A, Kung E. Superior performance of continuous over pulsatile flow ventricular assist devices in the single ventricle circulation: A computational study. J Biomech 2017; 52:48-54. [DOI: 10.1016/j.jbiomech.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/15/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
|
19
|
Liao S, Simpson B, Neidlin M, Kaufmann TAS, Li Z, Woodruff MA, Gregory SD. Numerical prediction of thrombus risk in an anatomically dilated left ventricle: the effect of inflow cannula designs. Biomed Eng Online 2016; 15:136. [PMID: 28155674 PMCID: PMC5260141 DOI: 10.1186/s12938-016-0262-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantation of a rotary blood pump (RBP) can cause non-physiological flow fields in the left ventricle (LV) which may trigger thrombosis. Different inflow cannula geometry can affect LV flow fields. The aim of this study was to determine the effect of inflow cannula geometry on intraventricular flow under full LV support in a patient specific model. METHODS Computed tomography angiography imaging of the LV was performed on a RBP candidate to develop a patient-specific model. Five inflow cannulae were evaluated, which were modelled on those used clinically or under development. The inflow cannulae are described as a crown like tip, thin walled tubular tip, large filleted tip, trumpet like tip and an inferiorly flared cannula. Placement of the inflow cannula was at the LV apex with the central axis intersecting the centre of the mitral valve. Full support was simulated by prescribing 5 l/min across the mitral valve. Thrombus risk was evaluated by identifying regions of stagnation. Rate of LV washout was assessed using a volume of fluid model. Relative haemolysis index and blood residence time was calculated using an Eulerian approach. RESULTS The inferiorly flared inflow cannula had the lowest thrombus risk due to low stagnation volumes. All cannulae had similar rates of LV washout and blood residence time. The crown like tip and thin walled tubular tip resulted in relatively higher blood damage indices within the LV. CONCLUSION Changes in intraventricular flow due to variances in cannula geometry resulted in different stagnation volumes. Cannula geometry does not appreciably affect LV washout rates and blood residence time. The patient specific, full support computational fluid dynamic model provided a repeatable platform to investigate the effects of inflow cannula geometry on intraventricular flow.
Collapse
Affiliation(s)
- Sam Liao
- Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032 Australia
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD 4059 Australia
| | - Benjamin Simpson
- School of Engineering, Griffith University, Southport, QLD 4215 Australia
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Tim A. S. Kaufmann
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Zhiyong Li
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD 4059 Australia
| | - Maria A. Woodruff
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD 4059 Australia
| | - Shaun D. Gregory
- Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032 Australia
- School of Engineering, Griffith University, Southport, QLD 4215 Australia
| |
Collapse
|
20
|
Influence of IABP-Induced Abdominal Occlusions on Aortic Hemodynamics: A Patient-Specific Computational Evaluation. ASAIO J 2016; 63:161-167. [PMID: 27861423 DOI: 10.1097/mat.0000000000000479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Intraaortic balloon pump (IABP) is used as temporary mechanical assistance in case of cardiovascular diseases, even if different hemodynamic problems and, thus, clinical complications may happen, such as the decrease of visceral perfusion. A computational fluid dynamic (CFD) study was carried out to investigate the effects of different IABP-induced abdominal occlusions on patient-specific aortic flow. Two possible sizes (25 and 34 cm) and two locations (2 and 3 cm) of the balloon were compared, modeling four abdominal occlusions and numerically reproducing IAB inflation/deflation behavior. The results highlighted that the perfusion in renal, mesenteric, and iliac arteries decreases when the abdominal occlusion increases with balloon inflation. The study illustrates also how the balloon size affects the flow in aorta vessels in both locations, and that the positioning is of little relevance for the 34 cm balloon, whereas it influences the aortic flow very much in case of 25 cm IAB. This analysis demonstrates how the IAB-induced occlusion may vary the abdominal circulation; therefore, the correct size and positioning are emphasized for patient's outcome.
Collapse
|