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Left Ventricular Assist Device Inflow Cannula Angle and Thrombosis Risk
Circulation: Heart Failure ( IF 9.7 ) Pub Date : 2018-04-01 , DOI: 10.1161/circheartfailure.117.004325
Venkat Keshav Chivukula 1 , Jennifer A. Beckman 1 , Anthony R. Prisco 1 , Todd Dardas 1 , Shin Lin 1 , Jason W. Smith 1 , Nahush A. Mokadam 1 , Alberto Aliseda 1 , Claudius Mahr 1
Affiliation  

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.


中文翻译:

左心室辅助装置流入套管角度和血栓形成风险

背景:随着静态供体供应的增加,心力衰竭的患病率不断上升,用于末期心力衰竭的左心室辅助装置(LVAD)治疗也在不断增长。轶事证据表明,LVAD流入插管的排列不良可能会增加血栓形成的风险,但尚未从机械或统计学角度探讨这种作用。我们的目的是阐明流入套管的手术成角对血栓形成的影响。
方法和结果:非稳定的计算流体动力学与计算建模和虚拟手术结合使用,可为5种不同的流入插管角度对通过左心室的血流进行建模。我们使用整体方法评估血栓形成性:基于血小板(拉格朗日)的指标评估血小板的机械环境,并结合基于流量的(欧拉)指标研究脑室内血流动力学。基于血小板切变应力历史和停留时间,定量评估每个LVAD流入插管角度的血栓形成潜力。LVAD流入套管的成角度强烈影响心室内的血流动力学。血小板行为表明某些流入套管角度的血栓形成潜力增高,可能导致血小板活化。
结论:从计算的流体动力学确定,流入套管相对于心尖轴线(连接二尖瓣和心室顶点的轴线)的角度大于7°会导致明显不利的血液动力学。结合拉格朗日和欧拉度量标准的计算血液动力学模拟是研究LVAD植入策略优化的强大工具,具有改善结果的长期潜力。
更新日期:2018-04-18
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