In Vitro Investigation of the Effect of Left Ventricular Assist Device Speed and Pulsatility Mode on Intraventricular He
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Annals of Biomedical Engineering ( 2020) https://doi.org/10.1007/s10439-020-02669-9
Original Article
In Vitro Investigation of the Effect of Left Ventricular Assist Device Speed and Pulsatility Mode on Intraventricular Hemodynamics FANETTE CHASSAGNE ,1 MARISSA MIRAMONTES,1 VENKAT KESHAV CHIVUKULA,2 SONG LI,3 JENNIFER A. BECKMAN,3 CLAUDIUS MAHR,3 and ALBERTO ALISEDA1 1
Mechanical Engineering, University of Washington, Seattle, WA, USA; 2Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, USA; and 3Division of Cardiology, University of Washington, Seattle, WA, USA (Received 23 June 2020; accepted 20 October 2020) Associate Editor Ender A. Finol oversaw the review of this article.
Abstract—Stroke has become the main cause of mortality and morbidity in patients treated with Left Ventricular Assist Devices (LVADs). The hemodynamics of the left ventricle are altered by the implantation of an LVAD, with the increase of thrombogenic flow patterns, such as stagnation regions. Time-resolved stereo particle image velocimetry (Stereo-PIV) measurements of the flow inside a patientspecific model of the left ventricle (LV) implanted with an LVAD were performed. The effects of LVAD speed, peripheral resistance and afterload were investigated. The impact of activating the LVAD pulsatility mode (periodic speed modulation) was also evaluated. Analysis of the velocity measurements in two orthogonal planes revealed stagnation zones which may be favorable to thrombus formation. Increasing LVAD speed, despite increasing the flow rate through the inflow cannula, does not automatically result in smaller stagnation regions. These results demonstrated the strong interdependence of peripheral resistance, afterload and flow through the LVAD. As a consequence, the pulsatility mode showed very limited effect on overall flow rate. However, it did reduce the size of high stagnation areas. This study showed how LVAD speed, peripheral resistance and afterload impact the complex intraventricular flow patterns in a ventricle implanted with an LVAD and quantify their thrombogenic risk. Keywords—LVAD, Particle image velocimetry, Hemodynamics.
Address correspondence to Fanette Chassagne, Mechanical Engineering, University of Washington, Seattle, WA, USA. Electronic mail: [email protected]
INTRODUCTION Left Ventricular Assist Device (LVAD) implantation is becoming more prevalent in the treatment of advanced heart failure (HF).20,26 Used as bridge-totransplant or as destination therapy, the average duration of LVAD therapy has increased and patient survival rates have improved significantly in the last decade.8 Despite these improvements, thrombo-embolic events, such as stroke, remain relatively common and carry the highest mortality and morbidity among LVAD complications.1,11,17,19 Third generation pumps have reduced the incidence of pump thrombosis dramatically but not the risk of stroke in an equivalent manner.11 The mechanisms leading to stroke are complex and have multiple origins. Thrombus can be formed in th
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