Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
While earlier studies reported no relevant effect of the HeartMate 3 (HM3) artificial pulse (AP) on bulk pump washout, its effect on regions with prolonged residence times remains unexplored. Using numerical simulations, we compared pump washout in the HM3 with and without AP with a focus on the cle...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.775780/full |
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| author | Peng Fang Peng Fang Jianjun Du Andrea Boraschi Silvia Bozzi Alberto Redaelli Marianne Schmid Daners Vartan Kurtcuoglu Filippo Consolo Filippo Consolo Diane de Zélicourt |
| author_facet | Peng Fang Peng Fang Jianjun Du Andrea Boraschi Silvia Bozzi Alberto Redaelli Marianne Schmid Daners Vartan Kurtcuoglu Filippo Consolo Filippo Consolo Diane de Zélicourt |
| author_sort | Peng Fang |
| collection | DOAJ |
| description | While earlier studies reported no relevant effect of the HeartMate 3 (HM3) artificial pulse (AP) on bulk pump washout, its effect on regions with prolonged residence times remains unexplored. Using numerical simulations, we compared pump washout in the HM3 with and without AP with a focus on the clearance of the last 5% of the pump volume. Results were examined in terms of flush-volume (Vf, number of times the pump was flushed with new blood) to probe the effect of the AP independent of changing flow rate. Irrespective of the flow condition, the HM3 washout scaled linearly with flush volume up to 70% washout and slowed down for the last 30%. Flush volumes needed to washout 95% of the pump were comparable with and without the AP (1.3–1.4 Vf), while 99% washout required 2.1–2.2 Vf with the AP vs. 2.5 Vf without the AP. The AP enhanced washout of the bend relief and near-wall regions. It also transiently shifted or eliminated stagnation regions and led to rapid wall shear stress fluctuations below the rotor and in the secondary flow path. Our results suggest potential benefits of the AP for clearance of fluid regions that might elicit in-pump thrombosis and provide possible mechanistic rationale behind clinical data showing very low rate of in-pump thrombosis with the HM3. Further optimization of the AP sequence is warranted to balance washout efficacy while limiting blood damage. |
| first_indexed | 2024-12-21T03:16:08Z |
| format | Article |
| id | doaj.art-9cc0fcacadb1495ba3f26ea1ae5e050b |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-21T03:16:08Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-9cc0fcacadb1495ba3f26ea1ae5e050b2022-12-21T19:17:49ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-03-01910.3389/fcvm.2022.775780775780Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?Peng Fang0Peng Fang1Jianjun Du2Andrea Boraschi3Silvia Bozzi4Alberto Redaelli5Marianne Schmid Daners6Vartan Kurtcuoglu7Filippo Consolo8Filippo Consolo9Diane de Zélicourt10School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen, Shenzhen, ChinaThe Interface Group, Institute of Physiology, University of Zurich, Zurich, SwitzerlandSchool of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen, Shenzhen, ChinaThe Interface Group, Institute of Physiology, University of Zurich, Zurich, SwitzerlandDepartment of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, ItalyDepartment of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, ItalyProduct Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, SwitzerlandThe Interface Group, Institute of Physiology, University of Zurich, Zurich, SwitzerlandAnesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, ItalyUniversità Vita Salute San Raffaele, Milano, ItalyThe Interface Group, Institute of Physiology, University of Zurich, Zurich, SwitzerlandWhile earlier studies reported no relevant effect of the HeartMate 3 (HM3) artificial pulse (AP) on bulk pump washout, its effect on regions with prolonged residence times remains unexplored. Using numerical simulations, we compared pump washout in the HM3 with and without AP with a focus on the clearance of the last 5% of the pump volume. Results were examined in terms of flush-volume (Vf, number of times the pump was flushed with new blood) to probe the effect of the AP independent of changing flow rate. Irrespective of the flow condition, the HM3 washout scaled linearly with flush volume up to 70% washout and slowed down for the last 30%. Flush volumes needed to washout 95% of the pump were comparable with and without the AP (1.3–1.4 Vf), while 99% washout required 2.1–2.2 Vf with the AP vs. 2.5 Vf without the AP. The AP enhanced washout of the bend relief and near-wall regions. It also transiently shifted or eliminated stagnation regions and led to rapid wall shear stress fluctuations below the rotor and in the secondary flow path. Our results suggest potential benefits of the AP for clearance of fluid regions that might elicit in-pump thrombosis and provide possible mechanistic rationale behind clinical data showing very low rate of in-pump thrombosis with the HM3. Further optimization of the AP sequence is warranted to balance washout efficacy while limiting blood damage.https://www.frontiersin.org/articles/10.3389/fcvm.2022.775780/fullleft ventricular assist device (LVAD)computational fluid dynamics (CFD)HeartMate 3 (HM3)pump thrombosiswashoutrotational speed modulation |
| spellingShingle | Peng Fang Peng Fang Jianjun Du Andrea Boraschi Silvia Bozzi Alberto Redaelli Marianne Schmid Daners Vartan Kurtcuoglu Filippo Consolo Filippo Consolo Diane de Zélicourt Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? Frontiers in Cardiovascular Medicine left ventricular assist device (LVAD) computational fluid dynamics (CFD) HeartMate 3 (HM3) pump thrombosis washout rotational speed modulation |
| title | Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? |
| title_full | Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? |
| title_fullStr | Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? |
| title_full_unstemmed | Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? |
| title_short | Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? |
| title_sort | insights into the low rate of in pump thrombosis with the heartmate 3 does the artificial pulse improve washout |
| topic | left ventricular assist device (LVAD) computational fluid dynamics (CFD) HeartMate 3 (HM3) pump thrombosis washout rotational speed modulation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.775780/full |
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