Left Ventricular Assist Device Inflow Cannula Insertion Depth Influences Thrombosis Risk
Left Ventricular Assist Device Inflow Cannula Insertion Depth Influences Thrombosis Risk
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DOI：
10.1097/mat.0000000000001068
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发表时间：
2020-07-01
期刊：
影响因子：
4.2
通讯作者：
Aliseda, Alberto
中科院分区：
文献类型：
--
作者：
Chivukula, Venkat Keshav;Beckman, Jennifer A.;Aliseda, Alberto
左心室辅助装置（LVAD）的使用持续增长。尽管最近技术取得了进步，LVAD患者仍然遭受毁灭性的并发症，包括中风和装置血栓形成。在影响血栓形成的几个变量中，我们假设流入静脉导管插入左心室（LV）的深度影响血流动力学和血栓形成风险。采用非定常计算流体动力学（CFD）方法，在患者衍生的左室、二尖瓣（MV）和左室辅助静脉插管计算模型中研究血流模式。使用血小板水平（拉格朗日）指标对两种静脉插管插入深度配置（减小12mm和常规27mm）进行了数十万个血小板的单独追踪，以量化血栓形成性。特别是在左室尺寸较小的患者中，更深的流入插管插入导致更高的血小板剪切应力史（SH），与明显异常的室内血流动力学一致。在这种更深的插入配置中，更大比例的血小板停留在区域的停留时间更长（RT），并积累了更高的SH。减少的流入深度配置促进了左室冲洗，降低了血小板SH。左室SH和RT的增加表明了流入插管深度对血小板活化的影响，增加了这些患者的卒中风险。流入管的插入深度应被视为优化LVAD治疗手术计划的一个机会。
Left ventricular assist device (LVAD) use has continued to grow. Despite recent advances in technology, LVAD patients continue to suffer from devastating complications, including stroke and device thrombosis. Among several variables affecting thrombogenicity, we hypothesize that insertion depth of the inflow cannula into the left ventricle (LV) influences hemodynamics and thrombosis risk. Blood flow patterns were studied in a patient-derived computational model of the LV, mitral valve (MV), and LVAD inflow cannula using unsteady computational fluid dynamics (CFD). Hundreds of thousands of platelets were tracked individually, for two inflow cannula insertion depth configurations (12 mm-reduced and 27 mm-conventional) using platelet-level (Lagrangian) metrics to quantify thrombogenicity. Particularly in patients with small LV dimensions, the deeper inflow cannula insertion resulted in much higher platelet shear stress histories (SH), consistent with markedly abnormal intraventricular hemodynamics. A larger proportion of platelets in this deeper insertion configuration was found to linger in the domain for long residence times (RT) and also accumulated much higher SH. The reduced inflow depth configuration promoted LV washout and reduced platelet SH. The increase of both SH and RT in the LV demonstrates the impact of inflow cannula depth on platelet activation and increased stroke risk in these patients. Inflow cannula depth of insertion should be considered as an opportunity to optimize surgical planning of LVAD therapy.