Hemodynamic effects of various support modes of continuous flow LVADs on the cardiovascular system: A numerical study

Song, Zhiming; Gu, Kai; Gao, Bin; Wan, Feng; Chang, Yu; Zeng, Yong

doi:10.12659/msm.890824

Cited by 18 publications

(8 citation statements)

References 46 publications

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“…The pulsatile support mode of BJUT-II VAD, proposed by Gao et al [ 19 ], is confirmed to be a better support mode for BJUT-II VAD. It has been proven that the pulsatile support mode can achieve better left ventricular unloading, higher arterial blood pulsatility, and better myocardial perfusion [ 23 ]. However, its effects on aortic hemodynamics are still under investigation.…”

Section: Discussionmentioning

confidence: 99%

Pulsatile Support Mode of BJUT-II Ventricular Assist Device (VAD) has Better Hemodynamic Effects on the Aorta than Constant Speed Mode: A Primary Numerical Study

Gao

Chang

et al. 2016

Med Sci Monit

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BackgroundBJUT-II VAD is a novel left ventricular assist device (LVADs), directly implanted into the ascending aorta. The pulsatile support mode is proposed to achieve better unloading performance than constant speed mode. However, the hemodynamic effects of this support mode on the aorta are still unclear. The aim of this study was to clarify the hemodynamic effects BJUT-II VAD under pulsatile support mode on the aorta.Material/MethodsComputational fluid dynamics (CFD) studies, based on a patient-specific aortic geometric model, were conducted. Wall shear stress (WSS), averaged WSS (avWSS), oscillatory shear index (OSI), and averaged helicity density (Ha) were calculated to compare the differences in hemodynamic effects between pulsatile support mode and constant speed mode.ResultsThe results show that avWSS under pulsatile support mode is significantly higher than that under constant speed mode (0.955Pa vs. 0.675Pa). Similarly, the OSI value under pulsatile mode is higher than that under constant speed mode (0.104 vs. 0.057). In addition, Ha under pulsatile mode for all selected cross-sections is larger than that under constant mode.ConclusionsBJUT-II VAD, under pulsatile control mode, may prevent atherosclerosis lesions and aortic remodeling. The precise effects of pulsatile support mode on atherosclerosis and aortic remodeling need to be further studied in animal experiments.

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Section: Discussionmentioning

confidence: 99%

Pulsatile Support Mode of BJUT-II Ventricular Assist Device (VAD) has Better Hemodynamic Effects on the Aorta than Constant Speed Mode: A Primary Numerical Study

Gao

Chang

et al. 2016

Med Sci Monit

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“…To sum up, LVADs are lifesaving surgical implants for the management of end-stage HF, which can serve either as a bridge to heart transplantation or as destination therapy. LVAD provides adequate circulatory support and mechanical unloading, which can even reverse the progression of heart failure and improve myocardial function [ 21 ]. However, LVAD-associated risk of thrombosis is a critical matter which can dramatically affect patient survival.…”

Section: Discussionmentioning

confidence: 99%

Continuous-Flow Left Ventricular Assist Device Thrombosis: A Danger Foreseen is a Danger Avoided

Fatullayev¹,

Samak

Sabashnikov³

et al. 2015

Med Sci Monit Basic Res

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Left ventricular assist devices (LVAD) are an increasingly implemented therapeutic intervention for patients with end-stage heart failure. A growing body of evidence, however, has shown an elevated risk of device thrombosis, a major complication jeopardizing the patient’s post-implantation survival. To date, multiple causative factors for LVAD thrombosis have been identified, such as internal shear stress, device material, infection, and inadequate anticoagulation.Understanding the mechanisms leading to LVAD thrombosis will not only enable device optimization, but also allow for better patient handling, hence improving post-implantation outcome. In this review we highlight the most commonly identified factors leading to LVAD thrombosis and discuss their mechanisms.

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“…Constant speed mode obtained the highest EBF with improved blood perfusion. Constant pressure head mode achieved the highest pressure pulsatility, which may be beneficial to maintain vascular function [ 96 ]. Ventricular interactions were not taken into account during these simulations.…”

Section: Control Of Rotary Blood Pumps and Current Developmentsmentioning

confidence: 99%

Mechanical Circulatory Support for Advanced Heart Failure: Are We about to Witness a New “Gold Standard”?

Capoccia

2016

JCDD

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The impact of left ventricular assist devices (LVADs) for the treatment of advanced heart failure has played a significant role as a bridge to transplant and more recently as a long-term solution for non-eligible candidates. Continuous flow left ventricular assist devices (CF-LVADs), based on axial and centrifugal design, are currently the most popular devices in view of their smaller size, increased reliability and higher durability compared to pulsatile flow left ventricular assist devices (PF-LVADs). The trend towards their use is increasing. Therefore, it has become mandatory to understand the physics and the mathematics behind their mode of operation for appropriate device selection and simulation set up. For this purpose, this review covers some of these aspects. Although very successful and technologically advanced, they have been associated with complications such as pump thrombosis, haemolysis, aortic regurgitation, gastro-intestinal bleeding and arterio-venous malformations. There is perception that the reduced arterial pulsatility may be responsible for these complications. A flow modulation control approach is currently being investigated in order to generate pulsatility in rotary blood pumps. Thrombus formation remains the most feared complication that can affect clinical outcome. The development of a preoperative strategy aimed at the reduction of complications and patient-device suitability may be appropriate. Patient-specific modelling based on 3D reconstruction from CT-scan combined with computational fluid dynamic studies is an attractive solution in order to identify potential areas of stagnation or challenging anatomy that could be addressed to achieve the desired outcome. The HeartMate II (axial) and the HeartWare HVAD (centrifugal) rotary blood pumps have been now used worldwide with proven outcome. The HeartMate III (centrifugal) is now emerging as the new promising device with encouraging preliminary results. There are now enough pumps on the market: it is time to focus on the complications in order to achieve the full potential and selling-point of this type of technology for the treatment of the increasing heart failure patient population.

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Hemodynamic effects of various support modes of continuous flow LVADs on the cardiovascular system: A numerical study

Cited by 18 publications

References 46 publications

Pulsatile Support Mode of BJUT-II Ventricular Assist Device (VAD) has Better Hemodynamic Effects on the Aorta than Constant Speed Mode: A Primary Numerical Study

Pulsatile Support Mode of BJUT-II Ventricular Assist Device (VAD) has Better Hemodynamic Effects on the Aorta than Constant Speed Mode: A Primary Numerical Study

Continuous-Flow Left Ventricular Assist Device Thrombosis: A Danger Foreseen is a Danger Avoided

Mechanical Circulatory Support for Advanced Heart Failure: Are We about to Witness a New “Gold Standard”?

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