Analysis of flow patterns in a ventricular assist device: a comparative study of particle image velocimetry and computational fluid dynamics

High-speed visualization of disturbed pathlines in axial flow ventricular assist device under pulsatile conditions

OBJECTIVE

To investigate potentially prothrombotic flow patterns within an axial flow ventricular assist device under clinically relevant pulsatile hemodynamic conditions.

METHODS

A transparent replica of the HeartMate-II left ventricular assist device (Thoratec, Pleasanton, Calif) was visualized using a high speed camera at both low and high frame rates (125 and 3000 fps). Three steady-state conditions were studied: nominal (4.5 lpm), low flow (3.0 lpm), and high flow (6.0 lpm). Time-varying conditions were introduced with an external pulsatile pump that modulated the flow rate by approximately ± 50% of the mean, corresponding to a pulsatility index of 1.0.

RESULTS

At nominal and high flow rates, the path lines within the upstream region were generally stable, well attached, and streamlined. As the flow rate was reduced below 3.8 lpm, a rapid transition to a chaotic velocity field occurred, exhibiting a large toroidal vortex adjacent to the upstream bearing. The pathlines in the downstream stator section were consistently chaotic for all hemodynamic conditions investigated. It was common to observe tracer particles trapped within recirculation bubbles and drawn retrograde, causing repeated contact with the bearing surfaces. The addition of pulsatility caused the flow field to become periodically chaotic during the diastolic portion of the cardiac cycle depending on the instantaneous flow rate and acceleration.

CONCLUSIONS

The contribution of pulsatility by the native heart may induce a periodic disturbance to an otherwise stable flow field within an axial flow ventricular assist device, particularly during the diastolic and decelerating portion of the cardiac cycle. Potentially prothrombotic flow features were found to occur periodically in the region of the upstream bearing.

NUMERICAL ANALYSIS OF AN AXIAL BLOOD PUMP WITH DIFFERENT IMPELLER BLADE HEIGHTS

Computational fluid dynamics (CFD) simulations of the flow in an axial blood pump with different blade heights (BH150, BH200 and BH250) were performed in the present study. The flow in the pump was assumed as steady and turbulent, and blood was treated as incompressible and Newtonian fluid. The flow rate increased with the rise in blade heights. At the impeller rotating speed of 20,000 rpm and a pressure of 100 mm Hg, the pump produces a flow rate up to 5 L/min in BH200 and BH250 models. The reverse flow and vortices have been identified in the BH150 and BH200 models in the outlet regions, but not for BH250 model. The high shear stress of the flow in the pump mainly occurred at the blade tips. The BH200 model achieved an expected flow rate up to 5 L/min with 90% of the shear stresses less than 500 Pa and the exposure time less than 22 ms, which has the acceptable shear stress level in the literature.

Three-dimensional flow characteristics in ventricular assist devices: impact of valve design and operating conditions

OBJECTIVE

The use of paracorporeal ventricular assist devices has become a well-established procedure for patients with cardiogenic shock. However, implantation of ventricular assist devices is often associated with severe complications, such as thrombosis inside the ventricular assist device and subsequent embolic events. It was the purpose of this study to use flow-sensitive 4-dimensional magnetic resonance imaging for a detailed analysis of the 3-dimensional (3D) flow dynamics inside a clinical routine ventricular assist device and to study the effect of different system adjustments and a new valve design on flow patterns.

METHODS

A routinely used clinical paracorporeal ventricular assist device was integrated into a magnetic resonance-compatible mock loop. Flow-sensitive 3D magnetic resonance imaging was performed to measure time-resolved 3-directional flow velocities (spatial resolution ∼ 1.2 mm, temporal resolution = 42.4 ms) in the entire device under ideal conditions (full fill, full empty, ejection fraction = 88%), insufficient filling (ejection fraction = 81%), and insufficient emptying (ejection fraction = 67%) of the pump chamber. In addition, a new valve design was evaluated. Flexible control and monitoring of pressures at inlet and outlet were used to generate realistic boundary conditions.

RESULTS

Flow pattern changes for different operating conditions were clearly identified and included reduced velocities during systolic outflow for impaired filling (78% reduction in pump flow compared with optimal operating conditions) and impaired clearing of the pump chamber for insufficient emptying (52% reduction). For all operating conditions, 3D visualization revealed vortex flow inside the ventricular assist device at typical locations of thrombus formation near the valve systems. Most noticeably, the new valve design provided similar global ventricular assist device function (pump flow 3.6 L/min), but vortex formation was eliminated.

CONCLUSIONS

The results of this study provide insight into the mechanisms underlying possible thrombus formation inside a ventricular assist device and the effect of different system adjustments. The presented methods may permit the optimization of future ventricular assist device systems with respect to optimal flow conditions.