An Accelerated Thrombosis Model for Computational Fluid Dynamics Simulations in Rotary Blood Pumps

Purpose Thrombosis ranks among the major complications in blood-carrying medical devices and a better understanding to influence the design related contribution to thrombosis is desirable. Over the past years many computational models of thrombosis have been developed. However, numerically cheap models able to predict localized thrombus risk in complex geometries are still lacking. The aim of the study was to develop and test a computationally efficient model for thrombus risk prediction in rotary blood pumps. Methods We used a two-stage approach to calculate thrombus risk. The first stage involves the computation of velocity and pressure fields by computational fluid dynamic simulations. At the second stage, platelet activation by mechanical and chemical stimuli was determined through species transport with an Eulerian approach. The model was compared with existing clinical data on thrombus deposition within the HeartMate II. Furthermore, an operating point and model parameter sensitivity analysis was performed. Results Our model shows good correlation (R2 > 0.93) with clinical data and identifies the bearing and outlet stator region of the HeartMate II as the location most prone to thrombus formation. The calculation of thrombus risk requires an additional 10–20 core hours of computation time. Conclusion The concentration of activated platelets can be used as a surrogate and computationally low-cost marker to determine potential risk regions of thrombus deposition in a blood pump. Relative comparisons of thrombus risk are possible even considering the intrinsic uncertainty in model parameters and operating conditions.

Driveline Features as Risk Factor for Infection in Left Ventricular Assist Devices: Meta-Analysis and Experimental Tests

Background: Risk factors for driveline infection (DLI) in patients with left ventricular assist devices are multifactorial. The aim of this study was to analyze the correlation between mechanical driveline features and DLI occurrence.Methods: A meta-analysis was conducted that included studies reporting DLI rates at 6 months after implantation of any of three contemporary devices (HVAD with Pellethane or Carbothane driveline, HeartMate II, and HeartMate 3). Further, outer driveline diameter measurements and ex-vivo experimental three-point bending and torsion tests were performed to compare the stiffness of the four different driveline types.Results: 21 studies with 5,393 patients were included in the meta-analysis. The mean weighted DLI rates ranged from 7.2% (HeartMate II) to 11.9% (HeartMate 3). The HeartMate II driveline had a significantly lower maximal bending force (Loadmax) (4.52 ± 0.19 N) compared to the Carbothane HVAD (8.50 ± 0.08 N), the HeartMate 3 (11.08 ± 0.3 N), and the Pellethane HVAD driveline (15.55 ± 0.14 N) (p < 0.001). The maximal torque (Torquemax) of the HeartMate II [41.44 (12.61) mNm] and the Carbothane HVAD driveline [46.06 (3.78) mNm] were significantly lower than Torquemax of the Pellethane HVAD [46.06 (3.78) mNm] and the HeartMate 3 [95.63 (26.60) mNm] driveline (p < 0.001). The driveline of the HeartMate 3 had the largest outer diameter [6.60 (0.58) mm]. A relationship between the mean weighted DLI rate and mechanical driveline features (Torquemax) was found, as the the HeartMate II driveline had the lowest Torquemax and lowest DLI rate, whereas the HeartMate 3 driveline had the highest Torquemax and highest DLI rate.Conclusions: Device-specific mechanical driveline features are an additional modifiable risk factor for DLI and may influence clinical outcomes of LVAD patients.

An accelerated thrombosis model for computational fluid dynamics simulations in rotary blood pumps

PurposeThrombosis is one of the major complications in blood-carrying medical devices and a better understanding to influence design of such devices is desirable. Over the past years many computational models of thrombosis have been developed. However, open questions remain about the applicability and implementation within a pump development process. The aim of the study was to develop and test a computationally efficient model for thrombus risk prediction in rotary blood pumps.MethodsWe used a two-stage approach to calculate thrombus risk. At the first stage, the velocity and pressure fields were computed by computational fluid dynamic (CFD) simulations. At the second stage, platelet activation by mechanical and chemical stimuli was determined through species transport with an Eulerian approach. The model was implemented in ANSYS CFX and compared with existing clinical data on thrombus deposition within the HeartMate II.ResultsOur model shows good correlation (R2>0.94) with clinical data and identifies the bearing and outlet stator region of the HeartMate II as the location most prone to thrombus formation. The calculation of platelet activation requires an additional 10-20 core hours of computation time.DiscussionThe concentration of activated platelets can be used as a surrogate marker to determine risk regions of thrombus deposition in a blood pump. Model expansion, e.g. by including more chemical species can easily be performed. We make our model openly available by implementing it for the FDA benchmark blood pump.DeclarationsFundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Open access funding enabled and organized by Projekt DEAL.Conflict of interestAll of the authors have nothing to disclose.Availability of data and materialThe raw data can be retrieved by request from the authors.Code availabilityThe implementation of the thrombus model in the FDA benchmark blood pump geometry is available on https://doi.org/10.5281/zenodo.5116063.Authors’ contributionsAll authors contributed to the study conception and design. CB developed the numerical model, performed the simulations, gathered, analysed and discussed the results. SGH, MN and US were involved in the analysis and discussion of the results. MN supervised the project. MN and CB wrote the manuscript based on the input of all co-authors. All co-authors read and approved the final version of the manuscript.

Correction to: Twisting and constriction of a HeartMate II driveline in the area of a repair site

A correction to this paper has been published: https://doi.org/10.1007/s10047-021-01280-6

Comparison of Outcomes of Enoxaparin Bridge Therapy in HeartMate II versus HeartWare HVAD Recipients

Background: There is a lack of robust data evaluating outcomes of enoxaparin “bridge” therapy in left ventricular assist device (LVAD) patients. Methods: We performed a retrospective study of HeartMate II (HM II) and HeartWare HVAD recipients that received therapeutic enoxaparin as “bridge” therapy to describe bleeding and thrombotic events and compare outcomes between devices. The primary endpoint was the incidence of bleeding within 30 days of “bridge” episode. Major bleeding was defined by INTERMACS criteria. Results: We evaluated 257 “bridge” episodes in 54 patients, 35 with a HM II device and 19 with an HVAD device that underwent 176 and 81 bridging episodes, respectively. The median INR prior to “bridge” was lower in the HM II group compared to the HVAD group (1.5 vs 1.7, P < .01), however, there was no difference in the median duration of “bridge” therapy (7 vs 7 days, P = .42). There were a total of 30 (12%) bleeding episodes, with the majority in the HM II group vs HVAD (26 [15%] vs 4 [5%], P = .02). We observed 3 (1%) thromboembolic events in 2 (4%) patients with an HVAD device. On multivariate analysis, the presence of a HM II device was associated with a 4-fold increased risk of bleeding. Conclusion: We found the use of enoxaparin “bridge” therapy to be associated with a higher incidence of bleeding in patients with a HM II device compared with an HVAD device. Assessment of device- and patient-specific factors should be evaluated to minimize bleeding events.