Understanding the influence of left ventricular assist device inflow cannula alignment and the risk of intraventricular thrombosis

BioMedical Engineering OnLine

David M. Kaye¹  Michael Neidlin²  Ulrich Steinseifer³  Sam Liao⁴  Benjamin Simpson⁵  Shaun Gregory⁶  Zhiyong Li⁷ 

[1] Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Baker Heart and Diabetes Institute, 3004, Melbourne, VIC, Australia;Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany;Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany;Department of Mechanical and Aerospace Engineering, Monash University, 3800, Clayton, VIC, Australia;Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany;Department of Mechanical and Aerospace Engineering, Monash University, 3800, Clayton, VIC, Australia;Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Baker Heart and Diabetes Institute, 3004, Melbourne, VIC, Australia;Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 4059, Kelvin Grove, QLD, Australia;Department of Engineering, Nottingham Trent University, Clifton Lane, NG11 8NS, Nottingham, UK;Department of Mechanical and Aerospace Engineering, Monash University, 3800, Clayton, VIC, Australia;Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Baker Heart and Diabetes Institute, 3004, Melbourne, VIC, Australia;Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 4059, Kelvin Grove, QLD, Australia;

关键词: Heart failure;    Cardiomyopathy;    Cardiovascular surgery;    Thrombosis;    Computational fluid dynamics;    Left ventricular assist device;    Cannula position;   

DOI  :  10.1186/s12938-021-00884-6

来源: Springer

【 摘 要 】

BackgroundAdverse neurological events associated with left ventricular assist devices (LVADs) have been suspected to be related to thrombosis. This study aimed to understand the risks of thrombosis with variations in the implanted device orientation. A severely dilated pulsatile patient-specific left ventricle, modelled with computational fluid dynamics, was utilised to identify the risk of thrombosis for five cannulation angles. With respect to the inflow cannula axis directed towards the mitral valve, the other angles were 25° and 20° towards the septum and 20° and 30° towards the free wall.ResultsInflow cannula angulation towards the free wall resulted in longer blood residence time within the ventricle, slower ventricular washout and reduced pulsatility indices along the septal wall. Based on the model, the ideal inflow cannula alignment to reduce the risk of thrombosis was angulation towards the mitral valve and up to parallel to the septum, avoiding the premature clearance of incoming blood.ConclusionsThis study indicates the potential effects of inflow cannulation angles and may guide optimised implantation configurations; however, the ideal approach will be influenced by other patient factors and is suspected to change over the course of support.

【 授权许可】

CC BY