The Influence of Rotary Blood Pump Speed Modulation on the Risk of Intraventricular Thrombosis

被引:28
作者
Liao, Sam [1 ,2 ,3 ]
Wu, Eric L. [2 ,4 ]
Neidlin, Michael [3 ]
Li, Zhiyong [1 ]
Simpson, Benjamin [5 ]
Gregory, Shaun D. [2 ,4 ,6 ]
机构
[1] Queensland Univ Technol, Inst Hlth & Biomed Innovat, Kelvin Grove, Qld 4059, Australia
[2] Prince Charles Hosp, Crit Care Res Grp, Innovat Cardiovasc Engn & Technol Lab, Chermside, Qld, Australia
[3] Rhein Westfal TH Aachen, Helmholtz Inst, Inst Appl Med Engn, Dept Cardiovasc Engn, Aachen, Germany
[4] Univ Queensland, Sch Med, St Lucia, Qld, Australia
[5] Nottingham Trent Univ, Dept Engn, Clifton Lane, Nottingham, England
[6] Monash Univ, Dept Mech & Aerosp Engn, Clayton, Vic, Australia
基金
英国医学研究理事会;
关键词
Heart failure; Pulsation; Computational model; Ventricular assist device; Ventricular flow; Cannula; VENTRICULAR ASSIST DEVICE; VASCULAR PULSATILITY; FLOW; STASIS; INFLOW; IMPACT; HEART; PULSE; SITE;
D O I
10.1111/aor.13330
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Rotary left ventricular assist devices (LVADs) are commonly operated at a constant speed, attenuating blood flow pulsatility. Speed modulation of rotary LVADs has been demonstrated to improve vascular pulsatility and pump washout. The effect of LVAD speed modulation on intraventricular flow dynamics is not well understood, which may have an influence on thromboembolic events. This study aimed to numerically evaluate intraventricular flow characteristics with a speed modulated LVAD. A severely dilated anatomical left ventricle was supported by a HeartWare HVAD in a three-dimensional multiscale computational fluid dynamics model. Three LVAD operating scenarios were evaluated: constant speed and sinusoidal co- and counter-pulsation. In all operating scenarios, the mean pump speed was set to restore the cardiac output to 5.0 L/min. Co- and counter-pulsation was speed modulated with an amplitude of 750 rpm. The risk of thrombosis was evaluated based on blood residence time, ventricular washout, kinetic energy densities, and a pulsatility index map. Blood residence time for co-pulsation was on average 1.8 and 3.7% lower than constant speed and counter-pulsation mode, respectively. After introducing fresh blood to displace preexisting blood for 10 cardiac cycles, co-pulsation had 1.5% less old blood in comparison to counter-pulsation. Apical energy densities were 84 and 27% higher for co-pulsation in comparison to counter-pulsation and constant speed mode, respectively. Co-pulsation had an increased pulsatility index around the left ventricular outflow tract and mid-ventricle. Improved flow dynamics with co-pulsation was caused by increased E-wave velocities which minimized blood stasis. In the studied scenario and from the perspective of intraventricular flow dynamics, co-pulsation of rotary LVADs could minimize the risk of intraventricular thrombosis.
引用
收藏
页码:943 / 953
页数:11
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