Medical College of Wisconsin
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Impact of LVAD Implantation Site on Ventricular Blood Stagnation. ASAIO J 2017 Jul/Aug;63(4):392-400

Date

12/24/2016

Pubmed ID

28009715

Pubmed Central ID

PMC5478478

DOI

10.1097/MAT.0000000000000503

Abstract

Treatment of end-stage heart failure includes cardiac transplantation or ventricular assist device (VAD) therapy. Although increasingly prevalent, current VAD therapy has inherent complications, including thrombosis. Studies have demonstrated that VAD implantation alters intracardiac blood flow, creating areas of stagnation that predispose to thrombus formation. Two potential surgical configurations exist for VAD implantation: through the apical or diaphragmatic surfaces of the heart. We hypothesized that diaphragmatic implantation causes more stagnation than apical implantation. We also hypothesized that intermittent aortic valve (AV) opening reduces stagnation of blood inside the left ventricle (LV) when compared with a closed AV. To test these hypotheses, a human LV geometry was recreated in silico and a VAD inflow cannula was virtually implanted in each configuration. A computational indicator-dilution study was conducted where "virtually dyed blood" was washed out of the LV by injecting blood with no dye. Simulations demonstrated a substantial reduction in stagnation with intermittent AV opening. In addition, virtual dye was cleared slightly faster in the apical configuration. Simulations from our study demonstrate the clinical importance of VAD management to allow intermittent opening of the AV to prevent subvalvular stagnation, and also suggests that apical configuration might be more hemodynamically favorable.

Author List

Prisco AR, Aliseda A, Beckman JA, Mokadam NA, Mahr C, Garcia GJM

Author

Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aortic Valve
Heart Failure
Heart Ventricles
Heart-Assist Devices
Hemodynamics
Humans
Thrombosis
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