LVAD Outflow Graft Angle and Thrombosis Risk

被引：64

作者：

Aliseda, Alberto ^{[1
]}

Chivukula, Venkat Keshav ^{[1
]}

Mcgah, Patrick ^{[1
]}

Prisco, Anthony R. ^{[2
]}

Beckman, Jenifer A. ^{[3
]}

Garcia, Guilherme J. M. ^{[2
]}

Mokadam, Nahush A. ^{[4
]}

Mahr, Claudius ^{[3
]}

机构：

[1] Univ Washington, Dept Mech Engn, Seattle, WA 98195 USA

[2] Med Coll Wisconsin, Biotechnol & Bioengn Ctr, Milwaukee, WI USA

[3] Univ Washington, Div Cardiol, Seattle, WA USA

[4] Univ Washington, Div Cardiothorac Surg, Seattle, WA USA

来源：

ASAIO JOURNAL | 2017年 / 63卷 / 01期

关键词：

left ventricular assist devices; thrombogenic risk; outflow graft; flow patterns; residence time; platelet shear stress history; Lagrangian tracking; VENTRICULAR ASSIST DEVICE; INDUCED PLATELET ACTIVATION; HEMODYNAMIC SHEAR-STRESS; HEART-FAILURE; AORTIC-INSUFFICIENCY; ASCENDING AORTA; FLOW; SIMULATIONS; TRANSPLANT; DYNAMICS;

D O I：

10.1097/MAT.0000000000000443

中图分类号：

R318 [生物医学工程];

学科分类号：

0831 ;

摘要：

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.

引用

页码：14 / 23

页数：10

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