Percutaneous double lumen cannula for right ventricle assist device system: A computational fluid dynamics study

Abstract

Objectives Our goal is to develop a double lumen cannula (DLC) for a percutaneous right ventricular assist device (pRVAD) in order to eliminate two open chest surgeries for RVAD installation and removal. The objective of this study was to evaluate the performance, flow pattern, blood hemolysis, and thrombosis potential of the pRVAD DLC. Methods Computational fluid dynamics (CFD), using the finite volume method, was performed on the pRVAD DLC. For Reynolds numbers <4000, the laminar model was used to describe the blood flow behavior, while shear-stress transport k-ω model was used for Reynolds numbers >4000. Bench testing with a 27 Fr prototype was performed to validate the CFD calculations. Results There was <1.3% difference between the CFD and experimental pressure drop results. The Lagrangian approach revealed a low index of hemolysis (0.012% in drainage lumen and 0.0073% in infusion lumen) at 5 l/min flow rate. Blood stagnancy and recirculation regions were found in the CFD analysis, indicating a potential risk for thrombosis. Conclusions The pRVAD DLC can handle up to 5 l/min flow with limited potential hemolysis. Further modification of the pRVAD DLC is needed to address blood stagnancy and recirculation.

The peripheral cannulas in extracorporeal life support

“…Wire reinforcement of the cannula walls is used to prevent kinking or collapse [10,16,26]. This type of design provides longer-term ambulatory application [18]. The cannulas that were manufactured from non-wire-reinforced polyurethane were deformed after insertion.…”

“…The right jugular vein cannulation has a much shorter route to the right atrium than the femoral cannulation. It can accommodate a much larger cannula for higher performance [18]. Using this type of cannula reduces the circuit size, which minimizes blood cells and circuit interaction.…”

“…Using this type of cannula reduces the circuit size, which minimizes blood cells and circuit interaction. Nevertheless, the cannula size is much larger than that of the standard peripheral cannula and it is not very elastic which complicates its admission [18,19]. If the fluoroscopy is not available, the insertion of the double-lumen cannula is not recommended, because of the risk of right ventricular perforation [19].…”

“…By minimizing the cannula thickness, the internal diameter increases thereby obtaining the highest flow efficiency and cannula flexibility with the smallest anatomical footprint [8,18]. Nowadays, the ultrathin wall of percutaneous cannula achieves a thickness of 0.48 mm for adult cannulas and 0.38 mm for pediatric cannulas [34].…”

“…Nowadays, the ultrathin wall of percutaneous cannula achieves a thickness of 0.48 mm for adult cannulas and 0.38 mm for pediatric cannulas [34]. Doublelumen cannula for VV-ECMO has a wall thickness of 0.7 mm with a thin membrane sleeve of the infusion lumen inside the main body with a wall thickness of 0.3 mm [18].…”