LVAD Outflow Graft Angle and Thrombosis Risk.
LVAD Outflow Graft Angle and Thrombosis Risk.
复制标题
DOI：
10.1097/mat.0000000000000443
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Mahr C
中科院分区：
文献类型：
--
作者：
Aliseda A;Chivukula VK;Mcgah P;Prisco AR;Beckman JA;Garcia GJ;Mokadam NA;Mahr C
本研究量化了各种 LVAD 流出移植物吻合角度的血栓形成潜力。本研究旨在阐明单一参数（流出移植物角度）对 LVAD 植入后主动脉根部血流模式相关血栓形成的影响。这是 LVAD 治疗的一个重要且鲜为人知的方面，因为多项研究表明患者之间和患者内部血栓形成的变异性很大，并且当前的 LVAD 植入策略并未纳入流出移植物角度优化。通过对拉格朗日粒子跟踪中的异常值进行统计处理，可以进行准确的血小板水平研究，证明流出移植物吻合角度对血栓形成性（以剪切应力积累为特征的血小板停留时间和激活状态）有很大影响，并且锐角吻合的流出移植物的血栓形成潜力显着降低。本研究提出的方法提供了一个设备中立的平台，用于对 LVAD 手术配置进行全面的血栓形成性评估，为晚期心力衰竭患者的长期治疗和护理提供以患者为中心的最佳手术策略。
This study quantifies thrombogenic potential of a wide range of LVAD outflow graft anastomosis angles through. This study aims at clarifying the influence of a single parameter (outflow graft angle) on the thrombogenesis associated with flow patterns in the aortic root after LVAD implantation. This is an important and poorly-understood aspect of LVAD therapy, because several studies have shown strong inter-and intra-patient thrombogenic variability and current LVAD implantation strategies do not incorporate outflow graft angle optimization. Accurate platelet-level investigation, enabled by statistical treatment of outliers in Lagrangian particle tracking, demonstrate a strong influence of outflow graft anastomoses angle on thrombogenicity (platelet residence times and activation state characterized by shear stress accumulation) with significantly reduced thrombogenic potential for acutely-angled anastomosed outflow grafts. The methodology presented in this study provides a device-neutral platform for conducting comprehensive thrombogenicity evaluation of LVAD surgical configurations, empowering optimal patient-focused surgical strategies for long-term treatment and care for advanced heart failure patients.