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Intraventricular thrombus formation in the LVAD-assisted heart studied in a mock circulatory loop

  • Advances in Biomechanics: From Foundations to Applications
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Abstract

Left ventricular assist devices (LVADs) are mechanical pumps that are surgically attached to the left ventricle and aorta. Clinical studies show that LVADs improve patient health and quality of life, and dramatically reduce the mortality of cardiac failure. During periods of high LVAD support, blood flow occurs entirely through the LVAD, the aortic valve is continuously closed, and the heart operates in series with the pump. Thus the normal fluid dynamics of intraventricular flow are altered and linked to the development of thrombus in both the native heart and LVAD. Our goal in this study was to simulate a patient with a recurring thrombus and quantify the variations in the flow field in the LV as the thrombus developed. Particle image velocimetry measurements of transparent silicone models were performed for a range of LVAD support conditions. Results show that the presence of a small thrombus in the LVOT creates a favorable condition for further growth, especially in the presence of high LVAD support. As the thrombus enlarges, it begins to affect the normal vortex-flow pattern, further reducing flow rate and pulsatility in the LVOT. Evaluation of vortex dynamics and stasis regions in both patients and experimental models of LVAD support yield quantitative metrics that can be used to assess the risk of thrombus and the development of strategies to reduce this risk in LVAD patients.

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Abbreviations

AoP:

Aortic pressure

AVO:

Aortic valve opening

BTR:

Bridge-to-recovery

BTT:

Bridge-to-transplant

CCW:

Counter clockwise

CO:

Cardiac output

CS:

Cardiac simulator

CW:

Clockwise

DT:

Destination therapy

EEP:

Energy equivalent pressure

HF:

Heart failure

HMII:

HeartMate II LVAD

KE:

Kinetic energy

LAP:

Left atrial pressure

LV:

Left ventricle

LVAD:

Left ventricular assist device

LVOT:

Left ventricular outflow tract

LVP:

Left ventricular pressure

MAP:

Mean arterial pressure

PI:

Pulsatility index, defined as (max–min)/mean flow or velocity

PP:

Pulse pressure

PIV:

Particle image velocimetry

Q-LVAD:

LVAD flow rate

Q-total:

Total aortic flow

SHE:

Surplus hemodynamic energy

Te:

Thromboembolism

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Acknowledgments

The authors greatly appreciate the support of the Mechanical Circulatory Support Department as well as the Echocardiography unit (especially Jennifer Key) at Sharp Memorial Hospital. Funding was provided by the American Heart Association 14GRNT20530004 (PI: May-Newman).

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Authors and Affiliations

  1. Department of Mechanical Engineering, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182-1323, USA

    Claudine Reider, Juyeun Moon, Varsha Ramesh, Ricardo Montes, Josue Campos, Brian Herold, Pablo Martinez-Legazpi & Karen May-Newman

  2. Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Pablo Martinez-Legazpi

  3. Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA, 92093, USA

    Pablo Martinez-Legazpi, Lorenzo Rossini & Juan Carlos del Alamo

  4. Mechanical Circulatory Support, Cardiothoracic Surgery, Sharp Memorial Hospital, San Diego, CA, 92123, USA

    Walter Dembitsky

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  1. Claudine Reider
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  2. Juyeun Moon
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  11. Karen May-Newman
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Correspondence to Karen May-Newman.

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Reider, C., Moon, J., Ramesh, V. et al. Intraventricular thrombus formation in the LVAD-assisted heart studied in a mock circulatory loop. Meccanica 52, 515–528 (2017). https://doi.org/10.1007/s11012-016-0433-z

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  • DOI: https://doi.org/10.1007/s11012-016-0433-z

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