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A Multi-Scale CFD Analysis of Patient-Specific Geometries to Tailor LVAD Cannula Implantation Under Pulsatile Flow Conditions: an investigation aimed at reducing stroke incidence in LVADs
Title
A Multi-Scale CFD Analysis of Patient-Specific Geometries to Tailor LVAD Cannula Implantation Under Pulsatile Flow Conditions: an investigation aimed at reducing stroke incidence in LVADs.
Creator
Prather, Ray, Kassab, Alain, Mansy, Hansen, Divo, Eduardo, University of Central Florida
Abstract / Description
A Left Ventricular Assist Device (LVAD) is a mechanical pump that provides temporary circulatory support when used as bridge-to-transplantation and relieves workload demand placed on a failing heart allowing for myocardia recovery when used as destination therapy. Stroke is the most devastating complication after ventricular assist device (VAD) implantation, with an incidence of 14-47% over 3-6 months. This complication due to thrombus formation and subsequent transport through the...
Show moreA Left Ventricular Assist Device (LVAD) is a mechanical pump that provides temporary circulatory support when used as bridge-to-transplantation and relieves workload demand placed on a failing heart allowing for myocardia recovery when used as destination therapy. Stroke is the most devastating complication after ventricular assist device (VAD) implantation, with an incidence of 14-47% over 3-6 months. This complication due to thrombus formation and subsequent transport through the vasculature to cerebral vessels continues to limit the widespread implementation of VAD therapy. Patient-specific computational fluid dynamics (CFD) analysis may elucidate ways to reduce this risk.We employed a multi-scale model of the aortic circulation in order to examine the effects on flow conditions resulting from varying the VAD cannula implantation location and angle of incidence of the anastomosis to the ascending aorta based on a patient-specific geometry obtained from CT scans. The multi-scale computation consists of a 0D lumped parameter model (LPM) of the circulation modeled via a 50 degree of freedom (DOF) electrical circuit analogy that includes an LVAD model coupled to a 3D computational fluid dynamics model of the circulation. An in-house adaptive Runge-Kutta method is utilized to solve the 50 DOF LPM, and the Starccm+ CFD code is utilized to solve the flowfield. This 0D-3D coupling for the flow is accomplished iteratively with the 0D LPM providing the pulsatile boundary conditions that drive the 3D CFD time-accurate computations of the flowfield. Investigated angle configurations include cannula implantations at 30(&)deg;, 60(&)deg; and 90(&)deg; to the right lateral wall of the ascending aorta. We also considered placements of the VAD cannula along the ascending aorta in which distances of the VAD anastomosis is varied relative to the take-off of the innominate artery. We implemented a mixed Eulerian-Lagrangian particle-tracking scheme to quantify the number of stroke-inducing particles reaching cerebral vessel outlets and included flow visualization through streamlines to identify regions of strong vorticity and flow stagnation, which can promote thrombus formation. Thrombi were modeled as spheres with perfectly elastic interactions numerically released randomly in time and space at cannula inlet plane. Based on clinical observation of the range of thrombus sizes encountered in such cases, particle diameters of 2.5mm and 3.5mm were investigated in our numerical computations. Pulsatile flow results for aforementioned angles suggest that a 90(&)deg; cannula implementation causes flow impingement on the left lateral aortic wall and appears to be highly thrombogenic due to large momentum losses and zones of large re-circulation and that shallow and intermediate cannula angles promote more regular flow carrying particles towards the lower body potentially reducing stroke risk. Indications from this pulsatile numerical study suggest that up to a 50% reduction in stroke rate can be achieve with tailoring of cannula implantation. Results are consistent with significant reduction in stroke incidence achieved by tailoring cannula implantation as reported in previous steady flow computations carried out by our group. As such, results of this study suggest that a simple surgical maneuver in the process of VAD implantation may significantly improve patient life.
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Date Issued
2015
Identifier
CFE0005689, ucf:50129
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005689
Hybrid Multi-Objective Optimization of Left Ventricular Assist Device Outflow Graft Anastomosis Orientation to Minimize Stroke Rate
Title
Hybrid Multi-Objective Optimization of Left Ventricular Assist Device Outflow Graft Anastomosis Orientation to Minimize Stroke Rate.
Creator
Lozinski, Blake, Kassab, Alain, Mansy, Hansen, DeCampli, William, University of Central Florida
Abstract / Description
A Left Ventricular Assist Device (LVAD) is a mechanical pump that is utilized as a bridge to transplantation for patients with a Heart Failure (HF) condition. More recently, LVADs have been also used as destination therapy and have provided an increase in the quality of life for patients with HF. However, despite improvements in VAD design and anticoagulation treatment, there remains a significant problem with VAD therapy, namely drive line infection and thromboembolic events leading to...
Show moreA Left Ventricular Assist Device (LVAD) is a mechanical pump that is utilized as a bridge to transplantation for patients with a Heart Failure (HF) condition. More recently, LVADs have been also used as destination therapy and have provided an increase in the quality of life for patients with HF. However, despite improvements in VAD design and anticoagulation treatment, there remains a significant problem with VAD therapy, namely drive line infection and thromboembolic events leading to stroke. This thesis focuses on a surgical maneuver to address the second of these issues, guided by previous steady flow hemodynamic studies that have shown the potential of tailoring the VAD outflow graft (VAD-OG) implantation in providing up to 50% reduction in embolization rates. In the current study, multi-scale pulsatile hemodynamics of the VAD bed is modeled and integrated in a fully automated multi-objective shape optimization scheme in which the VAD-OG anastomosis along the Ascending Aorta (AA) is optimized to minimize the objective function which include thromboembolic events to the cerebral vessels and wall shear stress (WSS). The model is driven by a time dependent pressure and flow boundary conditions located at the boundaries of the 3D domain through a 50 degree of freedom 0D lumped parameter model (LPM). The model includes a time dependent multi-scale Computational Fluid Dynamics (CFD) analysis of a patient specific geometry. Blood rheology is modeled as using the non-Newtonian Carreua-Yasuda model, while the hemodynamics are that of a laminar and constant density fluid. The pulsatile hemodynamics are resolved using the commercial CFD solver StarCCM+ while a Lagrangian particle tracking scheme is used to track constant density particles modeling thromobi released from the cannula to determine embolization rated of thrombi. The results show that cannula anastomosis orientation plays a large role when minimizing the objective function for patient derived aortic bed geometry used in this study. The scheme determined the optimal location of the cannula is located at 5.5 cm from the aortic root, cannula angle at 90 degrees and coronal angle at 8 degrees along the AA with a peak surface average WSS of 55.97 dy/cm2 and stroke percentile of 12.51%. A Pareto front was generated showing the range of 9.7% to 44.08% for stroke and WSS of 55.97 to 81.47 dy/cm2 ranged over 22 implantation configurations for the specific case studied. These results will further assist in the treatment planning for clinicians when implementing a LVAD.
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Date Issued
2019
Identifier
CFE0007833, ucf:52827
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007833