Multi-constituent simulation of thrombus formation at LVAD inlet cannula connection: Importance of Virchow's triad.
Multi-constituent simulation of thrombus formation at LVAD inlet cannula connection: Importance of Virchow's triad.
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LVAD入口套管连接处血栓形成的多组分模拟：Virchow三联征的重要性。
DOI：
10.1111/aor.13949
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发表时间：
2021-09
影响因子：
2.4
通讯作者：
中科院分区：
文献类型：
--
作者：
随着当前一代心室辅助装置（VAD）中泵血栓形成的减少，诸如出血或中风等不良事件的发生率仍然令人无法接受。VAD入口插管（IC）周围血栓形成已被强调为卒中事件的可能来源。最近的计算流体动力学（CFD）研究试图表征不同ic -心室构型的血栓形成风险。然而，纯粹的CFD模拟将血栓形成风险与基于流动特性的特定标准联系起来，很少考虑生化因素。本研究探讨了IC血栓形成的起源，包括Virchow's三要素：内皮损伤和高凝性。为此，进行了包括血小板活性和凝血反应在内的多尺度血栓形成模拟。我们的结果显示，在靠近IC壁的停滞区（∣u∣< 0.005 m/s）有显著的凝血酶形成。此外，高剪切介导的血小板活化被观察到在导管的前缘尖端。本研究揭示了围手术期脑室-导管交界处血栓形成的生化因素的重要性。这项研究是长期目标的第一步，包括临床相关的药理动力学，如肝素或阿司匹林，以模拟流入静脉血栓形成。
As pump thrombosis is reduced in current-generation ventricular assist devices (VAD), adverse events such as bleeding or stroke remain at unacceptable rates. Thrombosis around the VAD inlet cannula (IC) has been highlighted as a possible source of stroke events. Recent computational fluid dynamics (CFD) studies have attempted to characterize the thrombosis risk of different IC-ventricle configurations. However, purely CFD simulations relate thrombosis risk to ad hoc criteria based on flow characteristics, with little consideration of biochemical factors. This study investigates the genesis of IC thrombosis including two elements of the Virchow's triad: endothelial injury and hypercoagulability. To this end a multi-scale thrombosis simulation that includes platelet activity and coagulation reactions was performed. Our results show significant thrombin formation in stagnation regions (∣u∣ < 0.005 m/s) close to the IC wall. In addition, high shear-mediated platelet activation was observed over the leading-edge tip of the cannula. The current study reveals the importance of biochemical factors to the genesis of thrombosis at the ventricular-cannula junction in a perioperative state. This study is a first step toward the long-term objective of including clinically relevant pharmacological kinetics such as heparin or aspirin in simulations of inflow cannula thrombosis.
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DOI：
10.1177/0391398820904056
发表时间：
2021-01
期刊：
The International journal of artificial organs
影响因子：
--
作者：
Ghodrati M;Khienwad T;Maurer A;Moscato F;Zonta F;Schima H;Aigner P
通讯作者：
Aigner P
影响因子：
4.2
作者：
Curtis, AS;Wu, ZJJ;Antaki, JF
通讯作者：
Antaki, JF
影响因子：
4.2
作者：
Chivukula, Venkat Keshav;Beckman, Jennifer A.;Aliseda, Alberto
通讯作者：
Aliseda, Alberto
影响因子：
3.5
作者：
Rojano, Rodrigo Mendez;Mendez, Simon;Nicoud, Franck
通讯作者：
Nicoud, Franck
影响因子：
3.8
作者：
Goodman, PD;Barlow, ET;Solen, KA
通讯作者：
Solen, KA