Impact of heart failure severity on ventricular assist device haemodynamics: a computational study
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ORIGINAL ARTICLE
Impact of heart failure severity on ventricular assist device haemodynamics: a computational study Michael McElroy 1 & Antonios Xenakis 1 & Amir Keshmiri 1,2 Received: 17 April 2020 / Accepted: 24 August 2020 # The Author(s) 2020
Abstract Purpose This computational fluid dynamics study investigates the necessity of incorporating heart failure severity in the preoperative planning of left ventricular assist device (LVAD) configurations, as it is often omitted from studies on LVAD performance. Methods A parametric study was conducted examining a common range of LVAD to aortic root flow ratios (LVAD/AR-FR). A normal aortic root waveform was scaled by 5–30% in increments of 5% to represent the common range of flow pumped by the left ventricle for different levels of heart failure. A constant flow rate from the cannula compensated for the severity of heart failure in order to maintain normal total aortic flow rate. Results The results show that LVAD/AR-FR can have a significant but irregular impact on the perfusion and shear stress-related haemodynamic parameters of the subclavian and carotid arteries. Furthermore, it is found that a larger portion of the flow is directed towards the thoracic aorta at the expense of the carotid and subclavian arteries, regardless of LVAD/AR-FR. Conclusion The irregular behaviour found in the subclavian and carotid arteries highlights the necessity of including the LVAD/ AR-FR in the preoperative planning of an LVAD configuration, in order to accurately improve the effects on the cardiovascular system post implantation. Keywords Boundary conditions . Computational fluid dynamics . Heart failure . Human aorta . Cannula . Wall shear stress
Abbreviations AAo AR CFD CPB DAo FR HF IA LCCA LSA LV LVAD
LVAD/AR-FR Ascending aorta Aortic root Computational fluid dynamics Cardiopulmonary bypass Descending aorta Flow ratio Heart failure Innominate artery Left common carotid artery Left subclavian artery Left ventricle Left ventricular assistive device
* Amir Keshmiri [email protected] 1
2
Department of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester M13 9PL, UK Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M13 9PL, UK
OSI PC-MRI RCCA RRT RSA TAFR TAo TAV TAWSS WSS
Left ventricular assistive device to aortic root flow ratio Oscillatory shear index Phase contrast magnetic resonance imaging Right common carotid artery Relative residence time Right subclavian artery Time-averaged flow rate Thoracic aorta Time-averaged velocity Time-averaged wall shear stress Wall shear stress
Introduction Left ventricular assist devices (LVADs) are an established form of treatment for patients with heart failure and result in clear survival benefit. Although LVADs demonstrate significant survival improvements, they are also associated with
Res. Biomed. Eng.
postoperative complications such as ischemic and haemorrhagic stroke due to abnormal haemodynamics (Boyle et al
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