Aortic Hemodynamics of Spiral-Flow-Generated Mechanical Assistance

Mechanical circulatory support devices are being increasingly used as destination therapy in end-stage heart failure patients. Although current devices have significantly improved survival rates, the resulting hemodynamics remains nonphysiological. Spiral forms of blood flow are known to exist in the large arteries (eg, aorta) and serve as a biomimetic-motivation for generating these physiologically adapted flow regimes. We aimed to study the potential benefits of generating spiral flow at the mechanical circulatory support outflow graft and the resultant flow-fields in the aorta, including recirculation zones and endothelial wall shear stress (WSS) areas.

A three-dimensional model of an outflow graft virtually anastomosed end-to-side to an image-derived aortic arch was used in computational fluid dynamic simulations. To study the impact of both spiral flow modulation (clockwise/counterclockwise helical-flow content) and the outflow graft anastomosis angle (inferiorly/superiorly directed, anteriorly/posteriorly directed), flow velocities were measured, low/high WSS were computed, and fluid streamlines were visualized.

Increased helical-flow content reduced regions of low velocity (<5 cm/s), minimized areas exhibiting low WSS (<3 dyn/cm²), and concomitantly increased areas of high WSS (>80 dyn/cm²). The outflow graft anastomosis angle was a key determinant of aortic root washout and fluid-jet wall impingement. Despite counterclockwise spiral flow predominance in diminishing the size of recirculation/stasis zones compared to straight/clockwise flow, exceptions to this were noted with the superiorly directed and posteriorly directed graft placements.

Spiral flow-forms better tailored to the underlying three-dimensional aortic curvature and graft angle positioning is expected to help attenuate atherogenesis, preventing vascular remodeling and minimizing plaque formation/erosion in mechanically assisted circulation.