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Tailoring left ventricular assist device cannula implantation using coupled multi-scale multi-objective optimization
Abubakar Dankano1, Ray Prather2, Blake Lozinski1
1Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States.
Medical Engineering & Physics
|March 20, 2024
Summary
Optimizing outflow graft placement in Ventricular Assist Devices (VADs) significantly reduces cerebral thromboembolism. Tailoring implantation orientation minimizes thrombi, enhancing VAD safety and efficacy for patients.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Computational Fluid Dynamics
Background:
- Thromboembolic cerebral events are a major limitation for Ventricular Assist Device (VAD) implementation.
- Optimal outflow graft (OG) positioning is a promising strategy to mitigate post-implantation thromboembolism.
Purpose of the Study:
- To investigate the impact of outflow graft implantation orientation on cerebral embolization.
- To utilize shape optimization and multi-scale hemodynamics analysis to minimize thrombus formation and transport.
Main Methods:
- Developed a 3-D patient-specific computational fluid dynamics (CFD) model coupled with a 0-D lumped parameter model (LPM).
- Employed a Lagrangian particle-tracking scheme to simulate thrombus behavior.
- Integrated CFD-LPM coupling into a geometric shape optimization scheme to minimize cerebral embolization and particle residence times.
Main Results:
- A fivefold decrease in cerebral embolization was observed with optimal OG anastomosis orientation compared to non-optimal.
- Optimal implantation angles varied based on the origin of thrombus formation (OG, ventricle, or aortic root).
- Optimal configurations generally directed VAD flow along the central lumen of the aortic arch.
Conclusions:
- Outflow graft orientation is critical for reducing cerebral embolization in VAD patients.
- Identifying the most likely sites of thrombus formation in VAD patients is crucial for personalized implantation strategies.
