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Shields A, Williams K, Bhurwani MMS, Nagesh SVS, Chivukula VK, Bednarek DR, Rudin S, Davies J, Siddiqui AH, Ionita CN. Enhancing cerebral vasculature analysis with pathlength-corrected 2D angiographic parametric imaging: A feasibility study. Med Phys 2024; 51:2633-2647. [PMID: 37864843 PMCID: PMC10994741 DOI: 10.1002/mp.16808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND 2D angiographic parametric imaging (API) quantitatively extracts imaging biomarkers related to contrast flow and is conventionally applied to 2D digitally subtracted angiograms (DSA's). In the interventional suite, API is typically performed using 1-2 projection views and is limited by vessel overlap, foreshortening, and depth-integration of contrast motion. PURPOSE This work explores the use of a pathlength-correction metric to overcome the limitations of 2D-API: the primary objective was to study the effect of converting 3D contrast flow to projected contrast flow using a simulated angiographic framework created with computational fluid dynamics (CFD) simulations, thereby removing acquisition variability. METHODS The pathlength-correction framework was applied to in-silico angiograms, generating a reference (i.e., ground-truth) volumetric contrast distribution in four patient-specific intracranial aneurysm geometries. Biplane projections of contrast flow were created from the reference volumetric contrast distributions, assuming a cone-beam geometry. A Parker-weighted reconstruction was performed to obtain a binary representation of the vessel structure in 3D. Standard ray tracing techniques were then used to track the intersection of a ray from the focal spot with each voxel of the reconstructed vessel wall to a pixel in the detector plane. The lengths of each ray through the 3D vessel lumen were then projected along each ray-path to create a pathlength-correction map, where the pixel intensity in the detector plane corresponds to the vessel width along each source-detector ray. By dividing the projection sequences with this correction map, 2D pathlength-corrected in-silico angiograms were obtained. We then performed voxel-wise (3D) API on the ground-truth contrast distribution and compared it to pixel-wise (2D) API, both with and without pathlength correction for each biplane view. The percentage difference (PD) between the resultant API biomarkers in each dataset were calculated within the aneurysm region of interest (ROI). RESULTS Intensity-based API parameters, such as the area under the curve (AUC) and peak height (PH), exhibited notable changes in magnitude and spatial distribution following pathlength correction: these now accurately represent conservation of mass of injected contrast media within each arterial geometry and accurately reflect regions of stagnation and recirculation in each aneurysm ROI. Improved agreement was observed between these biomarkers in the pathlength-corrected biplane maps: the maximum PD within the aneurysm ROI is 3.3% with pathlength correction and 47.7% without pathlength correction. As expected, improved agreement with ROI-averaged ground-truth 3D counterparts was observed for all aneurysm geometries, particularly large aneurysms: the maximum PD for both AUC and PH was 5.8%. Temporal parameters (mean transit time, MTT, time-to-peak, TTP, time-to-arrival, TTA) remained unaffected after pathlength correction. CONCLUSIONS This study indicates that the values of intensity-based API parameters obtained with conventional 2D-API, without pathlength correction, are highly dependent on the projection orientation, and uncorrected API should be avoided for hemodynamic analysis. The proposed metric can standardize 2D API-derived biomarkers independent of projection orientation, potentially improving the diagnostic value of all acquired 2D-DSA's. Integration of a pathlength correction map into the imaging process can allow for improved interpretation of biomarkers in 2D space, which may lead to improved diagnostic accuracy during procedures involving the cerebral vasculature.
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Affiliation(s)
- Allison Shields
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Kyle Williams
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | | | - Swetadri Vasan Setlur Nagesh
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, Florida, USA 32901
| | - Daniel R. Bednarek
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Stephen Rudin
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Jason Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA 14203
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA 14203
| | - Ciprian N. Ionita
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
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Moyer JC, Chivukula VK, Taheri-Tehrani P, Sandhu S, Blaha C, Fissell WH, Roy S. An arteriovenous mock circulatory loop and accompanying bond graph model for in vitro study of peripheral intravascular bioartificial organs. Artif Organs 2024; 48:336-346. [PMID: 38073602 PMCID: PMC10960694 DOI: 10.1111/aor.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/28/2023] [Accepted: 11/07/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Silicon nanopore membrane-based implantable bioartificial organs are dependent on arteriovenous implantation of a mechanically robust and biocompatible hemofilter. The hemofilter acts as a low-resistance, high-flow network, with blood flow physiology similar to arteriovenous shunts commonly created for hemodialysis access. A mock circulatory loop (MCL) that mimics shunt physiology is an essential tool for refinement and durability testing of arteriovenous implantable bioartificial organs and silicon blood-interfacing membranes. We sought to develop a compact and cost-effective MCL to replicate flow conditions through an arteriovenous shunt and used data from the MCL and swine to inform a bond graph mathematical model of the physical setup. METHODS Flow physiology through bioartificial organ prototypes was obtained in the MCL and during extracorporeal attachment to swine for biologic comparison. The MCL was tested for stability overtime by measuring pressurewave variability over a 48-h period. Data obtained in vitro and extracorporeally informed creation of a bond graph model of the MCL. RESULTS The arteriovenous MCL was a cost-effective, portable system that reproduced flow rates and pressures consistent with a pulsatile arteriovenous shunt as measured in swine. MCL performance was stable over prolonged use, providing a cost-effective simulator for enhanced testing of peripherally implanted bioartificial organ prototypes. The corresponding bond graph model recapitulates MCL and animal physiology, offering a tool for further refinement of the MCL system.
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Affiliation(s)
- Jarrett C. Moyer
- Department of Bioengineering and Therapeutic Sciences, University of California – San Francisco, San Francisco, CA, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, USA
| | - Parsa Taheri-Tehrani
- Department of Bioengineering and Therapeutic Sciences, University of California – San Francisco, San Francisco, CA, USA
| | - Sukhveer Sandhu
- Department of Bioengineering and Therapeutic Sciences, University of California – San Francisco, San Francisco, CA, USA
| | - Charles Blaha
- Department of Bioengineering and Therapeutic Sciences, University of California – San Francisco, San Francisco, CA, USA
| | - William H. Fissell
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences, University of California – San Francisco, San Francisco, CA, USA
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Martinez J, Smegner K, Tomoda M, Motomura T, Chivukula VK. Encouraging Regular Aortic Valve Opening for EVAHEART 2 LVAD Support Using Virtual Patient Hemodynamic Speed Modulation Analysis. ASAIO J 2024; 70:207-216. [PMID: 38029749 DOI: 10.1097/mat.0000000000002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
This study focuses on investigating the EVAHEART 2 left ventricular assist device (LVAD) toward designing optimal pump speed modulation (PSM) algorithms for encouraging aortic valve (AV) flow. A custom-designed virtual patient hemodynamic model incorporating the EVAHEART 2 pressure-flow curves, cardiac chambers, and the systemic and pulmonary circulations was developed and used in this study. Several PSM waveforms were tested to evaluate their influence on the mean arterial pressure (MAP), cardiac output (CO), and AV flow for representative heart failure patients. Baseline speeds were varied from 1,600 to 2,000 rpm. For each baseline speed, the following parameters were analyzed: 1) PSM ratio (reduced speed/baseline speed), 2) PSM duration (3-7 seconds), 3) native ventricle contractility, and 4) patient MAP of 70 and 80 mm Hg. More than 2,000 rpm virtual patient scenarios were explored. A lower baseline speed (1,600 and 1,700 rpm) produced more opportunities for AV opening and more AV flow. Higher baseline speeds (1,800 and 2,000 rpm) had lower or nonexistent AV flow. When analyzing PSM ratios, a larger reduction in speed (25%) over a longer PSM (5+ seconds) duration produced the most AV flow. Lower patient MAP and increased native ventricle contractility also contributed to improving AV opening frequency and flow. This study of the EVAHEART 2 LVAD is the first to focus on leveraging PSM to enhance pulsatility and encourage AV flow. Increased AV opening frequency can benefit aortic root hemodynamics, thereby improving patient outcomes.
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Affiliation(s)
- Jasmine Martinez
- From the Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | | | | | | | - Venkat Keshav Chivukula
- From the Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
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Jourdain R, Chivukula VK, Bashur CA. Modeling Gasotransmitter Availability to Brain Capillary Endothelial Cells with Ultrasound-sensitive Microbubbles. Pharm Res 2023; 40:2399-2411. [PMID: 37783924 DOI: 10.1007/s11095-023-03606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Vascular cognitive impairment and dementia results from blood components passing through disrupted blood brain barriers (BBBs). Current treatments can reduce further progress of neuronal damage but do not treat the primary cause. Instead, these treatments typically aim to temporarily disrupt the BBB. Alternatively, this study computationally assessed the feasibility of delivering carbon monoxide (CO) from ultrasound-sensitive microbubbles (MBs) as a strategy to promote BBB repair and integrity. CO can interact with heme-containing compounds within cells and promote cell growth. However, careful dose control is critical for safety and efficacy because CO also binds at high affinity to hemoglobin (Hb). METHODS Ultrasound activation was simulated at the internal carotid artery, and CO released from the resulting MB rupture was tracked along the shortest path to the BBB for several activation times and doses. The CO dose available to brain capillary endothelial cells (BCECs) was predicted by considering hemodynamics, mass transport, and binding kinetics. RESULTS The half-life of CO binding to Hb indicated that CO is available to interact with BCECs for several cardiac cycles. Further, MB and COHb concentrations would not be near toxic levels and free Hb would be available. The axisymmetric model indicated that biologically-relevant CO concentrations will be available to BCECs, and these levels can be sustained with controlled ultrasound activation. A patient-specific geometry shows that while vessel tortuosity provides a heterogeneous response, a relevant CO concentration could still be achieved. CONCLUSIONS This computational study demonstrates feasibility of the CO / MB strategy, and that controlled delivery is important for viability of this strategy.
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Affiliation(s)
- Rubens Jourdain
- Department of Biomedical, Chemical Engineering and Science, Florida Institute of Technology, 150 West University Blvd., Melbourne, FL, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical, Chemical Engineering and Science, Florida Institute of Technology, 150 West University Blvd., Melbourne, FL, USA
| | - Chris A Bashur
- Department of Biomedical, Chemical Engineering and Science, Florida Institute of Technology, 150 West University Blvd., Melbourne, FL, USA.
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5
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Shields A, Setlur Nagesh SV, Rajagopal K, Bednarek DR, Rudin S, Chivukula VK. Application of 1,000 fps High-Speed Angiography to In-Vitro Hemodynamic Evaluation of Left Ventricular Assist Device Outflow Graft Configurations. ASAIO J 2023; 69:756-765. [PMID: 37140988 PMCID: PMC10524133 DOI: 10.1097/mat.0000000000001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Left ventricular assist device (LVAD)-induced hemodynamics are characterized by fast-moving flow with large variations in velocity, making quantitative assessments difficult with existing imaging methods. This study demonstrates the ability of 1,000 fps high-speed angiography (HSA) to quantify the effect of the surgical implantation angle of a LVAD outflow graft on the hemodynamics within the ascending aorta in vitro . High-speed angiography was performed on patient-derived, three-dimensional-printed optically opaque aortic models using a nonsoluble contrast media, ethiodol, as a flow tracer. Outflow graft configuration angles of 45° and 90° with respect to the central aortic axis were considered. Projected velocity distributions were calculated from the high-speed experimental sequences using two methods: a physics-based optical flow algorithm and tracking of radio-opaque particles. Particle trajectories were also used to evaluate accumulated shear stress. Results were then compared with computational fluid dynamics (CFD) simulations to confirm the results of the high-speed imaging method. Flow patterns derived from HSA coincided with the impingement regions and recirculation zones formed in the aortic root as seen in the CFD for both graft configurations. Compared with the 45° graft, the 90° configuration resulted in 81% higher two-dimensional-projected velocities (over 100 cm/s) along the contralateral wall of the aorta. Both graft configurations suggest elevated accumulated shear stresses along individual trajectories. Compared with CFD simulations, HSA successfully characterized the fast-moving flow and hemodynamics in each LVAD graft configuration in vitro , demonstrating the potential utility of this technology as a quantitative imaging modality.
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Affiliation(s)
- Allison Shields
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Swetadri Vasan Setlur Nagesh
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Keshava Rajagopal
- Division of Cardiac Surgery, Department of Surgery, Sidney
Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania,
USA
| | - Daniel R. Bednarek
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Stephen Rudin
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Florida Institute of
Technology, Melbourne, Florida, USA
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6
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Chivukula VK, Loera G, Dragoljic D, Martinez J, Beckman JA, Li S, Mahr C, Aliseda A. A Computational Hemodynamics Approach to Left Ventricular Assist Device (LVAD) Optimization Validated in a Large Patient Cohort. ASAIO J 2022; 68:932-939. [PMID: 34743140 DOI: 10.1097/mat.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With increasing use of left ventricular assist devices (LVAD) it is critical to devise strategies to optimize LVAD speed while controlling mean arterial pressure (MAP) and flow according to patient physiology. The complex interdependency between LVAD speed, MAP, and flow frequently makes optimization difficult under clinical conditions. We propose a method to guide this procedure in silico, narrowing the conditions to test clinically. A computational model of the circulatory network that simulates HF and LVAD support, incorporating LVAD pressure-flow curves was applied retrospectively to anonymized patient hemodynamics data from the University of Washington Medical Center. MAP management on 61 patient-specific computational models with a target of 70 mm Hg, resulting flow for a given LVAD speed was analyzed, and compared to a target output of 5 L/min. Before performing virtual MAP management, 51% had a MAP>70 mm Hg and CO>5 L/min, and 33% had a MAP>70 mm Hg and CO<5 L/min. After changing systemic resistance to meet the MAP target (without adjusting LVAD speed), 84% of cases resulted in CO higher than 5 L/min, with a median CO of 6.79 L/min, using the computational predictive model. Blood pressure management alone is insufficient in meeting both MAP and CO targets, due to the risk of hypervolemia, and requires appropriate LVAD speed optimization to achieve both targets, while preserving right heart health. Such computational tools can narrow down conditions to be tested for each patient, providing significant insight into the pump-patient interplay. LVAD hemodynamic optimization has the potential to reduce complications and improve outcomes.
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Affiliation(s)
| | - Gavin Loera
- Department of Biomedical Engineering, University of North Texas, Denton, Texas
| | - Dina Dragoljic
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, Florida
| | - Jasmine Martinez
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, Florida
| | | | - Song Li
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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7
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Hillner R, Perry L, Gong Y, Khayat A, Badheka A, Chivukula VK. CARD24: Assessment of EXCOR Operation Using Image-Based Quantitative Analysis. ASAIO J 2022. [DOI: 10.1097/01.mat.0000841032.22017.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Chivukula VK, Marsh L, Chassagne F, Barbour MC, Kelly CM, Levy S, Geindreau C, Roscoat SRD, Kim LJ, Levitt MR, Aliseda A. Lagrangian Trajectory Simulation of Platelets and Synchrotron Microtomography Augment Hemodynamic Analysis of Intracranial Aneurysms Treated With Embolic Coils. J Biomech Eng 2021; 143:1102198. [PMID: 33665669 DOI: 10.1115/1.4050375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 11/08/2022]
Abstract
As frequency of endovascular treatments for intracranial aneurysms increases, there is a growing need to understand the mechanisms for coil embolization failure. Computational fluid dynamics (CFD) modeling often simplifies modeling the endovascular coils as a homogeneous porous medium (PM), and focuses on the vascular wall endothelium, not considering the biomechanical environment of platelets. These assumptions limit the accuracy of computations for treatment predictions. We present a rigorous analysis using X-ray microtomographic imaging of the coils and a combination of Lagrangian (platelet) and Eulerian (endothelium) metrics. Four patient-specific, anatomically accurate in vitro flow phantoms of aneurysms are treated with the same patient-specific endovascular coils. Synchrotron tomography scans of the coil mass morphology are obtained. Aneurysmal hemodynamics are computationally simulated before and after coiling, using patient-specific velocity/pressure measurements. For each patient, we analyze the trajectories of thousands of platelets during several cardiac cycles, and calculate residence times (RTs) and shear exposure, relevant to thrombus formation. We quantify the inconsistencies of the PM approach, comparing them with coil-resolved (CR) simulations, showing the under- or overestimation of key hemodynamic metrics used to predict treatment outcomes. We fully characterize aneurysmal hemodynamics with converged statistics of platelet RT and shear stress history (SH), to augment the traditional wall shear stress (WSS) on the vascular endothelium. Incorporating microtomographic scans of coil morphology into hemodynamic analysis of coiled intracranial aneurysms, and augmenting traditional analysis with Lagrangian platelet metrics improves CFD predictions, and raises the potential for understanding and clinical translation of computational hemodynamics for intracranial aneurysm treatment outcomes.
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Affiliation(s)
| | - Laurel Marsh
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Fanette Chassagne
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Michael C Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Cory M Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195
| | - Samuel Levy
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195
| | - Christian Geindreau
- Laboratoire 3SR, Université Grenoble Alpes, 1270 Rue de la Piscine, Gières 38610, France
| | | | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195; Department of Radiology, University of Washington, Seattle, WA 98195
| | - Michael R Levitt
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195; Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195; Department of Radiology, University of Washington, Seattle, WA 98195
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195; Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195
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9
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Chivukula VK, Beckman JA, Prisco AR, Lin S, Dardas TF, Cheng RK, Farris SD, Smith JW, Mokadam NA, Mahr C, Aliseda A. Small Left Ventricular Size Is an Independent Risk Factor for Ventricular Assist Device Thrombosis. ASAIO J 2020; 65:152-159. [PMID: 29677037 DOI: 10.1097/mat.0000000000000798] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The prevalence of ventricular assist device (VAD) therapy has continued to increase due to a stagnant donor supply and growing advanced heart failure (HF) population. We hypothesize that left ventricular (LV) size strongly influences biocompatibility and risk of thrombosis. Unsteady computational fluid dynamics (CFD) was used in conjunction with patient-derived computational modeling and virtual surgery with a standard, apically implanted inflow cannula. A dual-focus approach of evaluating thrombogenicity was employed: platelet-based metrics to characterize the platelet environment and flow-based metrics to investigate hemodynamics. Left ventricular end-diastolic dimensions (LVEDds) ranging from 4.5 to 6.5 cm were studied and ranked according to relative thrombogenic potential. Over 150,000 platelets were individually tracked in each LV model over 15 cardiac cycles. As LV size decreased, platelets experienced markedly increased shear stress histories (SHs), whereas platelet residence time (RT) in the LV increased with size. The complex interplay between increased SH and longer RT has profound implications on thrombogenicity, with a significantly higher proportion of platelets in small LVs having long RT times and being subjected to high SH, contributing to thrombus formation. Our data suggest that small LV size, rather than decreased VAD speed, is the primary pathologic mechanism responsible for the increased incidence of thrombosis observed in VAD patients with small LVs.
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Affiliation(s)
| | | | - Anthony R Prisco
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Shin Lin
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Todd F Dardas
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Stephen D Farris
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Jason W Smith
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Nahush A Mokadam
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, Washington
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10
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Marsh LMM, Barbour MC, Chivukula VK, Chassagne F, Kelly CM, Levy SH, Kim LJ, Levitt MR, Aliseda A. Platelet Dynamics and Hemodynamics of Cerebral Aneurysms Treated with Flow-Diverting Stents. Ann Biomed Eng 2019; 48:490-501. [PMID: 31549329 DOI: 10.1007/s10439-019-02368-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023]
Abstract
Flow-diverting stents (FDS) are used to treat cerebral aneurysms. They promote the formation of a stable thrombus within the aneurysmal sac and, if successful, isolate the aneurysmal dome from mechanical stresses to prevent rupture. Platelet activation, a mechanism necessary for thrombus formation, is known to respond to biomechanical stimuli, particularly to the platelets' residence time and shear stress exposure. Currently, there is no reliable method for predicting FDS treatment outcomes, either a priori or after the procedure. Eulerian computational fluid dynamic (CFD) studies of aneurysmal flow have searched for predictors of endovascular treatment outcome; however, the hemodynamics of thrombus formation cannot be fully understood without considering the platelets' trajectories and their mechanics-triggered activation. Lagrangian analysis of the fluid mechanics in the aneurysmal vasculature provides novel metrics by tracking the platelets' residence time (RT) and shear history (SH). Eulerian and Lagrangian parameters are compared for 19 patient-specific cases, both pre- and post-treatment, to assess the degree of change caused by the FDS and subsequent treatment efficacy.
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Affiliation(s)
- Laurel M M Marsh
- Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA
| | - Michael C Barbour
- Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA
| | - Venkat Keshav Chivukula
- Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA
| | - Fanette Chassagne
- Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA
| | - Cory M Kelly
- Neurological Surgery, University of Washington, Seattle, WA, USA.,Stroke & Applied NeuroScience Center, University of Washington, Seattle, WA, USA
| | - Samuel H Levy
- Neurological Surgery, University of Washington, Seattle, WA, USA.,Stroke & Applied NeuroScience Center, University of Washington, Seattle, WA, USA
| | - Louis J Kim
- Neurological Surgery, University of Washington, Seattle, WA, USA.,Stroke & Applied NeuroScience Center, University of Washington, Seattle, WA, USA.,Radiology, University of Washington, Seattle, WA, USA
| | - Michael R Levitt
- Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA.,Neurological Surgery, University of Washington, Seattle, WA, USA.,Stroke & Applied NeuroScience Center, University of Washington, Seattle, WA, USA.,Radiology, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA. .,Neurological Surgery, University of Washington, Seattle, WA, USA. .,Stroke & Applied NeuroScience Center, University of Washington, Seattle, WA, USA.
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11
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Chivukula VK, Beckman JA, Prisco AR, Dardas T, Lin S, Smith JW, Mokadam NA, Aliseda A, Mahr C. Left Ventricular Assist Device Inflow Cannula Angle and Thrombosis Risk. Circ Heart Fail 2019; 11:e004325. [PMID: 29666072 DOI: 10.1161/circheartfailure.117.004325] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND As heart failure prevalence continues to increase in the setting of a static donor supply, left ventricular assist device (LVAD) therapy for end-stage heart failure continues to grow. Anecdotal evidence suggests that malalignment of the LVAD inflow cannula may increase thrombosis risk, but this effect has not been explored mechanistically or quantified statistically. Our objective is to elucidate the impact of surgical angulation of the inflow cannula on thrombogenicity. METHODS AND RESULTS Unsteady computational fluid dynamics is used in conjunction with computational modeling and virtual surgery to model flow through the left ventricle for 5 different inflow cannula angulations. We use a holistic approach to evaluate thrombogenicity: platelet-based (Lagrangian) metrics to evaluate the platelet mechanical environment, combined with flow-based (Eulerian) metrics to investigate intraventricular hemodynamics. The thrombogenic potential of each LVAD inflow cannula angulation is quantitatively evaluated based on platelet shear stress history and residence time. Intraventricular hemodynamics are strongly influenced by LVAD inflow cannula angulation. Platelet behavior indicates elevated thrombogenic potential for certain inflow cannula angles, potentially leading to platelet activation. Our analysis demonstrates that the optimal range of inflow angulation is within 0±7° of the left ventricular apical axis. CONCLUSIONS Angulation of the inflow cannula >7° from the apical axis (axis connecting mitral valve and ventricular apex) leads to markedly unfavorable hemodynamics as determined by computational fluid dynamics. Computational hemodynamic simulations incorporating Lagrangian and Eulerian metrics are a powerful tool for studying optimization of LVAD implantation strategies, with the long-term potential of improving outcomes.
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Affiliation(s)
- Venkat Keshav Chivukula
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Jennifer A Beckman
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Anthony R Prisco
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Todd Dardas
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Shin Lin
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Jason W Smith
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Nahush A Mokadam
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Alberto Aliseda
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.)
| | - Claudius Mahr
- Department of Mechanical Engineering (V.K.C., A.A.), Division of Cardiology (J.A.B., T.D., S.L., C.M.), and Division of Cardiothoracic Surgery (J.W.S., N.A.M.), University of Washington, Seattle. Department of Medicine, University of Minnesota, Minneapolis (A.R.P.).
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12
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Li S, Beckman JA, Welch NG, Bjelkengren J, Masri SC, Minami E, Stempien-Otero A, Levy WC, O'Brien KD, Lin S, Farris SD, Cheng RK, Wood G, Koomalsingh K, Kirkpatrick J, McCabe J, Leary PJ, Chassagne F, Chivukula VK, Aliseda A, Mahr C. Accuracy of Doppler blood pressure measurement in continuous-flow left ventricular assist device patients. ESC Heart Fail 2019; 6:793-798. [PMID: 31099483 PMCID: PMC6676287 DOI: 10.1002/ehf2.12456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 04/28/2019] [Indexed: 12/21/2022] Open
Abstract
Aims Accurate blood pressure (BP) measurement in continuous‐flow ventricular assist device (CF‐VAD) patients is imperative to reduce stroke risk. This study assesses the accuracy of the Doppler opening pressure method compared with the gold standard arterial line method in CF‐VAD patients. Methods and results In a longitudinal cohort of HeartMate II and HVAD patients, arterial line BP and simultaneously measured Doppler opening pressure were obtained. Overall correlation, agreement between Doppler opening pressure and arterial line mean vs. systolic pressure, and the effect of arterial pulsatility on the accuracy of Doppler opening pressure were analysed. A total of 1933 pairs of Doppler opening pressure and arterial line pressure readings within 1 min of each other were identified in 154 patients (20% women, mean age 55 ± 15, 50% HeartMate II and 50% HVAD). Doppler opening pressure had good correlation with invasive mean arterial pressure (r = 0.742, P < 0.0001) and more closely approximated mean than systolic BP (mean error 2.4 vs. −8.4 mmHg). Arterial pulsatility did not have a clinically significant effect on the accuracy of the Doppler opening pressure method. Conclusions Doppler opening pressure should be the standard non‐invasive method of BP measurement in CF‐VAD patients.
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Affiliation(s)
- Song Li
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jennifer A Beckman
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Nathan G Welch
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Jason Bjelkengren
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Sofia Carolina Masri
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Elina Minami
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - April Stempien-Otero
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Wayne C Levy
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Shin Lin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Stephen D Farris
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Richard K Cheng
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Gregory Wood
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin Koomalsingh
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - James Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - James McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Peter J Leary
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Fanette Chassagne
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | | | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, 98195, USA
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13
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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. [PMID: 30354870 DOI: 10.1177/0391398818806162.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
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Affiliation(s)
- Matteo Selmi
- 1 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.,2 Department of Surgery, Division of Cardiac Surgery, Università di Verona, Verona, Italy
| | - Wei-Che Chiu
- 3 Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | | | - Giulio Melisurgo
- 5 Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudius Mahr
- 6 Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- 4 Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Emiliano Votta
- 1 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alberto Redaelli
- 1 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Marvin J Slepian
- 3 Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.,7 Departments of Medicine and Biomedical Engineering, The University of Arizona, Tucson, AZ, USA
| | - Danny Bluestein
- 3 Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Federico Pappalardo
- 5 Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milano, Italy.,8 Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milano, Italy.,9 Università Vita-Salute San Raffaele, Milano, Italy
| | - Filippo Consolo
- 1 Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.,8 Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milano, Italy.,9 Università Vita-Salute San Raffaele, Milano, Italy
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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15
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Lawson TB, Scott-Drechsel DE, Chivukula VK, Rugonyi S, Thornburg KL, Hinds MT. Hyperglycemia Alters the Structure and Hemodynamics of the Developing Embryonic Heart. J Cardiovasc Dev Dis 2018; 5:jcdd5010013. [PMID: 29439517 PMCID: PMC5872361 DOI: 10.3390/jcdd5010013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 12/27/2022] Open
Abstract
Congenital heart defects (CHDs) represent the most common form of human birth defects; approximately one-third of heart defects involve malformations of the outflow tract (OFT). Maternal diabetes increases the risk of CHD by 3-5 fold. During heart organogenesis, little is known about the effects of hyperglycemia on hemodynamics, which are critical to normal heart development. Heart development prior to septation in the chick embryo was studied under hyperglycemic conditions. Sustained hyperglycemic conditions were induced, raising the average plasma glucose concentration from 70 mg/dL to 180 mg/dL, akin to the fasting plasma glucose of a patient with diabetes. The OFTs were assessed for structural and hemodynamic alterations using optical coherence tomography (OCT), confocal microscopy, and microcomputed tomography. In hyperglycemic embryos, the endocardial cushions of the proximal OFT were asymmetric, and the OFTs curvature and torsion were significantly altered. The blood flow velocity through the OFT of hyperglycemic embryos was significantly decreased, including flow reversal in 30% of the cardiac cycle. Thus, hyperglycemia at the onset of gestation results in asymmetric proximal endocardial cushions, abnormal OFT curvature, and altered hemodynamics in the developing heart. If present in humans, these results may identify early developmental alterations that contribute to the increased risk for cardiac malformations in babies from diabetic mothers.
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Affiliation(s)
- Taylor B Lawson
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Devon E Scott-Drechsel
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Venkat Keshav Chivukula
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Sandra Rugonyi
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Kent L Thornburg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Monica T Hinds
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA.
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16
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Abstract
This study quantifies thrombogenic potential (TP) of a wide range of left ventricular assist device (LVAD) outflow graft anastomosis angles through state-of-the-art techniques: 3D imaged-based patient-specific models created via virtual surgery and unsteady computational fluid dynamics with Lagrangian particle tracking. This study aims at clarifying the influence of a single parameter (outflow graft angle) on the thrombogenesis associated with flow patterns in the aortic root after LVAD implantation. This is an important and poorly-understood aspect of LVAD therapy, because several studies have shown strong inter and intrapatient thrombogenic variability and current LVAD implantation strategies do not incorporate outflow graft angle optimization. Accurate platelet-level investigation, enabled by statistical treatment of outliers in Lagrangian particle tracking, demonstrates a strong influence of outflow graft anastomoses angle on thrombogenicity (platelet residence times and activation state characterized by shear stress accumulation) with significantly reduced TP for acutely-angled anastomosed outflow grafts. The methodology presented in this study provides a device-neutral platform for conducting comprehensive thrombogenicity evaluation of LVAD surgical configurations, empowering optimal patient-focused surgical strategies for long-term treatment and care for advanced heart failure patients.
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Affiliation(s)
- Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | | | - Patrick McGah
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Anthony R. Prisco
- Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Guilherme J.M. Garcia
- Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nahush A Mokadam
- Division of Cardiothoracic Surgery, University of Washington, Seattle, WA, USA
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, WA, USA
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17
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Midgett M, Chivukula VK, Dorn C, Wallace S, Rugonyi S. Blood flow through the embryonic heart outflow tract during cardiac looping in HH13-HH18 chicken embryos. J R Soc Interface 2016; 12:20150652. [PMID: 26468069 DOI: 10.1098/rsif.2015.0652] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Blood flow is inherently linked to embryonic cardiac development, as haemodynamic forces exerted by flow stimulate mechanotransduction mechanisms that modulate cardiac growth and remodelling. This study evaluated blood flow in the embryonic heart outflow tract (OFT) during normal development at each stage between HH13 and HH18 in chicken embryos, in order to characterize changes in haemodynamic conditions during critical cardiac looping transformations. Two-dimensional optical coherence tomography was used to simultaneously acquire both structural and Doppler flow images, in order to extract blood flow velocity and structural information and estimate haemodynamic measures. From HH13 to HH18, peak blood flow rate increased by 2.4-fold and stroke volume increased by 2.1-fold. Wall shear rate (WSR) and lumen diameter data suggest that changes in blood flow during HH13-HH18 may induce a shear-mediated vasodilation response in the OFT. Embryo-specific four-dimensional computational fluid dynamics modelling at HH13 and HH18 complemented experimental observations and indicated heterogeneous WSR distributions over the OFT. Characterizing changes in haemodynamics during cardiac looping will help us better understand the way normal blood flow impacts proper cardiac development.
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Affiliation(s)
- Madeline Midgett
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
| | - Calder Dorn
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR, USA
| | - Samantha Wallace
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR, USA
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
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18
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Abstract
We analyzed heart wall motion and blood flow dynamics in chicken embryos using in vivo optical coherence tomography (OCT) imaging and computational fluid dynamics (CFD) embryo-specific modeling. We focused on the heart outflow tract (OFT) region of day 3 embryos, and compared normal (control) conditions to conditions after performing an OFT banding intervention, which alters hemodynamics in the embryonic heart and vasculature. We found that hemodynamics and cardiac wall motion in the OFT are affected by banding in ways that might not be intuitive a priori. In addition to the expected increase in ventricular blood pressure, and increase blood flow velocity and, thus, wall shear stress (WSS) at the band site, the characteristic peristaltic-like motion of the OFT was altered, further affecting flow and WSS. Myocardial contractility, however, was affected only close to the band site due to the physical restriction on wall motion imposed by the band. WSS were heterogeneously distributed in both normal and banded OFTs. Our results show how banding affects cardiac mechanics and can lead, in the future, to a better understanding of mechanisms by which altered blood flow conditions affect cardiac development leading to congenital heart disease.
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Affiliation(s)
- Venkat Keshav Chivukula
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA 98195, USA;
| | - Sevan Goenezen
- Department of Mechanical Engineering, Texas A&M University, College Station, TX 77840, USA;
| | - Aiping Liu
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, ECB 2145, Madison, WI 53706, USA;
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Ave. M/C CH13B, Portland, OR 97239, USA;
- Correspondence: ; Tel.: +1-503-419-9310; Fax: +1-503-418-9311
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19
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Goenezen S, Chivukula VK, Midgett M, Phan L, Rugonyi S. 4D subject-specific inverse modeling of the chick embryonic heart outflow tract hemodynamics. Biomech Model Mechanobiol 2015; 15:723-43. [PMID: 26361767 DOI: 10.1007/s10237-015-0720-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/17/2015] [Indexed: 01/10/2023]
Abstract
Blood flow plays a critical role in regulating embryonic cardiac growth and development, with altered flow leading to congenital heart disease. Progress in the field, however, is hindered by a lack of quantification of hemodynamic conditions in the developing heart. In this study, we present a methodology to quantify blood flow dynamics in the embryonic heart using subject-specific computational fluid dynamics (CFD) models. While the methodology is general, we focused on a model of the chick embryonic heart outflow tract (OFT), which distally connects the heart to the arterial system, and is the region of origin of many congenital cardiac defects. Using structural and Doppler velocity data collected from optical coherence tomography, we generated 4D ([Formula: see text]) embryo-specific CFD models of the heart OFT. To replicate the blood flow dynamics over time during the cardiac cycle, we developed an iterative inverse-method optimization algorithm, which determines the CFD model boundary conditions such that differences between computed velocities and measured velocities at one point within the OFT lumen are minimized. Results from our developed CFD model agree with previously measured hemodynamics in the OFT. Further, computed velocities and measured velocities differ by [Formula: see text]15 % at locations that were not used in the optimization, validating the model. The presented methodology can be used in quantifications of embryonic cardiac hemodynamics under normal and altered blood flow conditions, enabling an in-depth quantitative study of how blood flow influences cardiac development.
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Affiliation(s)
- Sevan Goenezen
- Department of Mechanical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Madeline Midgett
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Ly Phan
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA.
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20
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Chivukula VK, Krog BL, Nauseef JT, Henry MD, Vigmostad SC. Alterations in cancer cell mechanical properties after fluid shear stress exposure: a micropipette aspiration study. ACTA ACUST UNITED AC 2015; 7:25-35. [PMID: 25908902 PMCID: PMC4405123 DOI: 10.2147/chc.s71852] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Over 90% of cancer deaths result not from primary tumor development, but from metastatic tumors that arise after cancer cells circulate to distal sites via the circulatory system. While it is known that metastasis is an inefficient process, the effect of hemodynamic parameters such as fluid shear stress (FSS) on the viability and efficacy of metastasis is not well understood. Recent work has shown that select cancer cells may be able to survive and possibly even adapt to FSS in vitro. The current research seeks to characterize the effect of FSS on the mechanical properties of suspended cancer cells in vitro. Nontransformed prostate epithelial cells (PrEC LH) and transformed prostate cancer cells (PC-3) were used in this study. The Young's modulus was determined using micropipette aspiration. We examined cells in suspension but not exposed to FSS (unsheared) and immediately after exposure to high (6,400 dyn/cm2) and low (510 dyn/cm2) FSS. The PrEC LH cells were ~140% stiffer than the PC-3 cells not exposed to FSS. Post-FSS exposure, there was an increase of ~77% in Young's modulus after exposure to high FSS and a ~47% increase in Young's modulus after exposure to low FSS for the PC-3 cells. There was no significant change in the Young's modulus of PrEC LH cells post-FSS exposure. Our findings indicate that cancer cells adapt to FSS, with an increased Young's modulus being one of the adaptive responses, and that this adaptation is specific only to PC-3 cells and is not seen in PrEC LH cells. Moreover, this adaptation appears to be graded in response to the magnitude of FSS experienced by the cancer cells. This is the first study investigating the effect of FSS on the mechanical properties of cancer cells in suspension, and may provide significant insights into the mechanism by which some select cancer cells may survive in the circulation, ultimately leading to metastasis at distal sites. Our findings suggest that biomechanical analysis of cancer cells could aid in identifying and diagnosing cancer in the future.
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Affiliation(s)
- Venkat Keshav Chivukula
- Department of Biomedical Engineering, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA
| | - Benjamin L Krog
- Department of Biomedical Engineering, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA ; Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA
| | - Jones T Nauseef
- Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA
| | - Michael D Henry
- Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA
| | - Sarah C Vigmostad
- Department of Biomedical Engineering, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA
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AlMomani TD, Vigmostad SC, Chivukula VK, Al-zube L, Smadi O, BaniHani S. Red blood cell flow in the cardiovascular system: a fluid dynamics perspective. Crit Rev Biomed Eng 2012; 40:427-440. [PMID: 23339650 DOI: 10.1615/critrevbiomedeng.v40.i5.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The dynamics of red blood cells (RBCs) is one of the major aspects of the cardiovascular system that has been studied intensively in the past few decades. The dynamics of biconcave RBCs are thought to have major influences in cardiovascular diseases, the problems associated with cardiovascular assistive devices, and the determination of blood rheology and properties. This article provides an overview of the works that have been accomplished in the past few decades and aim to study the dynamics of RBCs under different flow conditions. While significant progress has been made in both experimental and numerical studies, a detailed understanding of the behavior of RBCs is still faced with many challenges. Experimentally, the size of RBCs is considered to be a major limitation that allows measurements to be performed under conditions similar to physiological conditions. In numerical computations, researchers still are working to develop a model that can cover the details of the RBC mechanics as it deforms and moves in the bloodstream. Moreover, most of reported computational models have been confined to the behavior of a single RBC in 2-dimensional domains. Advanced models are yet to be developed for accurate description of RBC dynamics under physiological flow conditions in 3-dimensional regimes.
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Affiliation(s)
- Thakir D AlMomani
- Department of Biomedical Engineering, The Hashemite University, Zarqa, Jordan.
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