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Ventricular Assist Device Implantation Configurations Impact Overall Mechanical Circulatory Support System
Wei-Che Chiu1, Yared Alemu, Allison J McLarty
1From the *Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York; †Department of Surgery, Stony Brook University, Stony Brook, New York; and ‡Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 7, 2016
Summary
Optimizing ventricular assist device (VAD) implantation configurations, including cannula angles and orientations, can significantly reduce thrombogenic potential. This approach enhances device thromboresistance for improved patient outcomes in advanced heart failure.
Area of Science:
- Biomedical Engineering
- Cardiovascular Science
- Medical Device Technology
Background:
- Ventricular assist devices (VADs) are crucial for advanced heart failure but can cause thrombotic complications due to high shear stress.
- Platelet activation by VADs increases thrombogenicity, necessitating system-level evaluation beyond device design alone.
- Surgical implantation configurations are suspected to influence the overall thrombogenicity of VAD systems.
Purpose of the Study:
- To numerically simulate and evaluate the thrombogenic potential (TP) of different implantation configurations for HeartAssist 5 (HA5) and HeartMate II (HMII) VADs.
- To identify specific surgical parameters that minimize platelet stress accumulation and enhance VAD thromboresistance.
- To demonstrate how optimizing implantation strategies can reduce the thrombogenic footprint of VAD systems.
Main Methods:
- Numerical simulations were performed on HA5 and HMII VADs under varied inflow cannula angles (115°, 140°), VAD circumferential orientations (0°, 30°, 60°), and outflow graft anastomotic angles (60°, 90°).
- Platelet stress accumulation was calculated along flow paths.
- A probability density function, termed 'thrombogenic footprint', was used as a proxy for thrombogenic potential (TP).
Main Results:
- A 140° inflow cannula angle for the HA5 VAD consistently reduced TP, irrespective of VAD orientation.
- The optimal VAD circumferential orientation for lowest TP was 60° for HA5 and 0° for HMII.
- A 60° anastomotic angle for the HA5 VAD's outflow graft resulted in lower TP.
Conclusions:
- Optimizing VAD implantation configurations, such as cannula angle and VAD orientation, effectively reduces the overall system's thrombogenic potential.
- Combining VAD design improvements with tailored surgical implantation strategies can enhance thromboresistance.
- These findings suggest a pathway to improve clinical outcomes for patients with implanted VADs through configuration optimization.
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