PediaFlow™ Maglev Ventricular Assist Device: A Prescriptive Design Approach

Multiobjective Optimization of Rotodynamic Blood Pumps: The Use Case of a Cavopulmonary Assist Device

Comprehensive optimization of rotodynamic blood pumps (RBPs) requires the consideration of three partially conflicting objectives: size, hemocompatibility, and motor efficiency. Optimizing these individual objectives independently, the potential of multiobjective optimizations often remains untapped. This study aimed at the multiobjective optimization of an RBP for cavopulmonary support accounting for all three objectives simultaneously. Hydraulic and electromagnetic design spaces were characterized using computational fluid dynamics and computational electromagnetics, respectively. Design variables included secondary flow gap widths, impeller diameters, and stator heights. The size objective encompassed the RBP widths and heights, the hemocompatibility objective was a weighted composite measure of well-established metrics, and the motor objective was determined by motor losses. Multiobjective optimization was performed through Pareto analysis. 81 designs were considered, and 21 Pareto-optimal designs were identified. The Pareto analysis indicated that hemocompatibility performance could be improved by 72.4% with a concomitant 1.5% reduction in the baseline pump volume. This, however, entailed an increase in motor losses by 0.2 W, while still meeting design requirements, with maximum local temperature rises remaining below 0.4 K. The multiobjective optimization led to a Pareto front, demonstrating the feasibility to improve hemocompatibility at reduced pump volume, however, at the cost of a diminished yet still acceptable motor performance.

In Vitro models for thrombogenicity testing of blood-recirculating medical devices

INTRODUCTION

Blood-recirculating medical devices, such as mechanical circulatory support (MCS), extracorporeal membrane oxygenators (ECMO), and hemodialyzers, are commonly used to treat or improve quality of life in patients with cardiac, pulmonary, and renal failure, respectively. As part of their regulatory approval, guidelines for thrombosis evaluation in pre-clinical development have been established. In vitro testing evaluates a device's potential to produce thrombosis markers in static and dynamic flow loops.

AREAS COVERED

This review focuses on in vitro static and dynamic models to assess thrombosis in blood-recirculating medical devices. A summary of key devices is followed by a review of molecular markers of contact activation. Current thrombosis testing guidance documents, ISO 10993-4, ASTM F-2888, and F-2382 will be discussed, followed by analysis of their application to in vitro testing models.

EXPERT OPINION

In general, researchers have favored in vivo models to thoroughly evaluate thrombosis, limiting in vitro evaluation to hemolysis. In vitro studies are not standardized and it is often difficult to compare studies on similar devices. As blood-recirculating devices have advanced to include wearable and implantable artificial organs, expanded guidelines standardizing in vitro testing are needed to identify the thrombotic potential without excessive use of in vivo resources during pre-clinical development.

Preclinical performance of a pediatric mechanical circulatory support device: The PediaFlow ventricular assist device

OBJECTIVES

The PediaFlow (HeartWare International, Inc, Framingham, Mass) is a miniature, implantable, rotodynamic, fully magnetically levitated, continuous-flow pediatric ventricular assist device. The fourth-generation PediaFlow was evaluated in vitro and in vivo to characterize performance and biocompatibility.

METHODS

Supported by 2 National Heart, Lung, and Blood Institute contract initiatives to address the limited options available for pediatric patients with congenital or acquired cardiac disease, the PediaFlow was developed with the intent to provide chronic cardiac support for infants as small as 3 kg. The University of Pittsburgh-led Consortium evaluated fourth-generation PediaFlow prototypes both in vitro and within a preclinical ovine model (n = 11). The latter experiments led to multiple redesigns of the inflow cannula and outflow graft, resulting in the implantable design represented in the most recent implants (n = 2).

RESULTS

With more than a decade of extensive computational and experimental efforts spanning 4 device iterations, the AA battery-sized fourth-generation PediaFlow has an operating range of 0.5 to 1.5 L/min with minimal hemolysis in vitro and excellent hemocompatibility (eg, minimal hemolysis and platelet activation) in vivo. The pump and finalized accompanying implantable components demonstrated preclinical hemodynamics suitable for the intended pediatric application for up to 60 days.

CONCLUSIONS

Designated a Humanitarian Use Device for "mechanical circulatory support in neonates, infants, and toddlers weighing up to 20 kg as a bridge to transplant, a bridge to other therapeutic intervention such as surgery, or as a bridge to recovery" by the Food and Drug Administration, these initial results document the biocompatibility and potential of the fourth-generation PediaFlow design to provide chronic pediatric cardiac support.

Systematic Design of a Magnetically Levitated Brushless DC Motor for a Reversible Rotary Intra-Aortic Blood Pump

The IntraVAD is a miniature intra-aortic ventricular assist device (VAD) designed to work in series with the compromised left ventricle. A reverse-rotation control (RRc) mode has been developed to increase myocardial perfusion and reduce ventricular volume. The RRc mode includes forward rotation in systole and reverse rotation in diastole, which requires the IntraVAD to periodically reverse its rotational direction in synchrony with the cardiac cycle. This periodic reversal leads to changes in pressure force over the impeller, which makes the entire system less stable. To eliminate the mechanical wear of a contact bearing and provide active control over the axial position of the rotor, a miniature magnetically levitated bearing (i.e., the PM-Coil module) composed of two concentric permanent magnetic (PM) rings and a pair of coils-one on each side-was proposed to provide passive radial and active axial rotor stabilization. In the early design stage, the numerical finite element method (FEM) was used to optimize the geometry of the brushless DC (BLDC) motor and the maglev module, but constructing a new model each time certain design parameters were adjusted required substantial computation time. Because the design criteria for the module had to be modified to account for the magnetic force produced by the motor and for the hemodynamic changes associated with pump operation, a simplified analytic expression was derived for the expected magnetic forces. Suitable bearings could then be designed capable of overcoming these forces without repeating the complicated FEM simulation for the motor. Using this method at the initial design stage can inform the design of the miniature maglev BLDC motor for the proposed pulsatile axial-flow VAD.

Rotary mechanical circulatory support systems

A detailed survey of the current trends and recent advances in rotary mechanical circulatory support systems is presented in this paper. Rather than clinical reports, the focus is on technological aspects of these rehabilitating devices as a reference for engineers and biomedical researchers. Existing trends in flow regimes, flow control, and bearing mechanisms are summarized. System specifications and applications of the most prominent continuous-flow ventricular assistive devices are provided. Based on the flow regime, pumps are categorized as axial flow, centrifugal flow, and mixed flow. Unique characteristics of each system are unveiled through an examination of the structure, bearing mechanism, impeller design, flow rate, and biocompatibility. A discussion on the current limitations is provided to invite more studies and further improvements.

Steady and transient flow analysis of a magnetically levitated pediatric VAD: time varying boundary conditions

A magnetically levitated impeller within a pediatric ventricular assist device operates under highly transient flow conditions. In this study, computational analyses were performed to investigate the hydraulic performance and fluid forces on the impeller under the steady and dynamic flow conditions, including: 1) time-varying boundary conditions (TVBC) considering a pulsed pump flow rate and pulsed left ventricular pressure; 2) transient rotational sliding interfaces (TRSI) to capture virtual blade rotation. Under steady flow conditions, the pressure generation for 0.5-6 l/min over 6000-10000 rpm was 20-140 mmHg; experimental validation agreed to within 6-27%. Under transient flow conditions, the outflow pressure of the pump increased with higher inlet pressure during the TVBC simulation. During TVBC, the pressure rise across the pump decreased as a function of higher flow rates and increased as a function of lower flow rates. The radial fluid forces varied directly with the flow rate by demonstrating larger forces at higher flow rates. For TRSI simulations, pressure fluctuations due the blade passage frequency were found to have 12 peaks per revolution, having magnitude ranges of 
0.7 and 1.0 mmHg for 8 000 and 10 000 rpm, respectively. At 8 000 rpm, the fluid forces ranged from 1.15-1.17 N (axial) and 0.02-0.11 N (radial). Transient simulations model implant scenarios more realistically and provide critical information about the fluid conditions in the pump.

Design Optimization of a Wearable Artificial Pump-Lung Device With Computational Modeling

The heart-lung machine has commonly been used to replace the functions of both the heart and lungs during open heart surgeries or implemented as extracorporeal membrane oxygenation (ECMO) to provide cardiopulmonary support of the heart and lungs. The traditional heart-lung system consists of multiple components and is bulky. It can only be used for relatively short-term support. The concept of the wearable artificial pump-lung is to combine the functions of the blood pumping and gas transfer in a single, compact unit for cardiopulmonary or respiratory support for patients suffering from cardiac failure or respiratory failure, or both, and to allow patients to be ambulatory. To this end, a wearable artificial lung (APL) device is being developed by integrating a magnetically levitated centrifugal impeller with a hollow fiber membrane bundle. In this study, we utilized a computational fluid dynamics based performance optimization with a heuristic scheme to derive geometrical design parameters for the wearable APL device. The configuration and dimensions of the impeller and the diffuser, the required surface area of fiber membranes and the overall geometrical dimensions of the blood flow path of the APL device were considered. The design optimization was iterated based on the fluid dynamic objective parameters (pressure head, pressure distribution, axial force acting on the impeller, shear stress), blood damage potential (hemolysis and platelet activation), and mass transfer (oxygen partial pressure and saturation). Through the design optimization, an optimized APL device was computationally derived. A physical prototype of the designed APL device was fabricated and tested in vitro. The experimental data showed that the optimized APL can provide adequate blood pumping and oxygen transfer over the range of intended operating conditions.

Antaki J, Verkaik J, Snyder S, Ricci M. Computational Fluid Dynamics-Based Design Optimization for an Implantable Miniature Maglev Pediatric Ventricular Assist Device

Computational fluid dynamics (CFD)-based design optimization was applied to achieve the finalized design of the PediaFlow^® PF4, a magnetically levitated rotodynamic pediatric ventricular assist device. It features a streamlined blood-flow path with a single annular fluid passage between the rotor and the stationary housing. The resulting impeller is composed of a first-stage mixed-flow section having four blades at the conical nose region followed by a second-stage fully axial-flow section with three blades within the annular gap region. A stator with three inwardly-directed vanes is provided at the conical tail region to recover pressure and straighten the flow. CFD predictions of head and efficiency characteristics agreed remarkably well with the validation experimental data: with overprediction of head by <7 mmHg over the entire operational range and a slight overprediction in best efficiency by ∼1%. The new optimized PF4 extended the maximum flow range of the previous PF3 device by more than 100% to over 2.3 liter per minute (LPM) for the same range of operating speeds, and doubled the maximum hydraulic efficiency to ∼27%. Evaluation of hemolysis was performed by a Lagrangian particle-tracking technique with analysis of regional contributions to the overall blood damage. The simulation revealed that hemolysis increases with an increase in both the flow rate and rotor speed but not necessarily with just an increase in flow rate at a constant rotor speed. At the flow rate of 1.0 LPM and a head of 138 mmHg, PF4 has a hemolysis index of 0.0032 compared to 0.0058 produced by PF3 at the same flow rate with a head of 48 mmHg. Numerical simulation of radial fluid forces performed by the CFD model with an eccentric rotor revealed the presence of negative fluid stiffness that was monotonically related to both flow and speed. Finally, conjugate heat transfer analysis predicted temperature rise adjacent to the motor to be inversely proportional to the length, but not exceeding ∼2 °C over the intended range of operation. In conclusion, CFD-based design optimization greatly expedited and facilitated the completion of the PediaFlow^® flow path and contributed to the system-wide optimization to produce a miniature maglev pump with exceptional hemocompatibility.

Cardiac assist with a twist: apical torsion as a means to improve failing heart function

Changes in muscle fiber orientation across the wall of the left ventricle (LV) cause the apex of the heart to turn 10-15 deg in opposition to its base during systole and are believed to increase stroke volume and lower wall stress in healthy hearts. Studies show that cardiac torsion is sensitive to various disease states, which suggests that it may be an important aspect of cardiac function. Modern imaging techniques have sparked renewed interest in cardiac torsion dynamics, but no work has been done to determine whether mechanically augmented apical torsion can be used to restore function to failing hearts. In this report, we discuss the potential advantages of this approach and present evidence that turning the cardiac apex by mechanical means can displace a clinically significant volume of blood from failing hearts. Computational models of normal and reduced-function LVs were created to predict the effects of applied apical torsion on ventricular stroke work and wall stress. These same conditions were reproduced in anesthetized pigs with drug-induced heart failure using a custom apical torsion device programmed to rotate over various angles during cardiac systole. Simulations of applied 90 deg torsion in a prolate spheroidal computational model of a reduced-function pig heart produced significant increases in stroke work (25%) and stroke volume with reduced fiber stress in the epicardial region. These calculations were in substantial agreement with corresponding in vivo measurements. Specifically, the computer model predicted torsion-induced stroke volume increases from 13.1 to 14.4 mL (9.9%) while actual stroke volume in a pig heart of similar size and degree of dysfunction increased from 11.1 to 13.0 mL (17.1%). Likewise, peak LV pressures in the computer model rose from 85 to 95 mm Hg (11.7%) with torsion while maximum ventricular pressures in vivo increased in similar proportion, from 55 to 61 mm Hg (10.9%). These data suggest that: (a) the computer model of apical torsion developed for this work is a fair and accurate predictor of experimental outcomes, and (b) supra-physiologic apical torsion may be a viable means to boost cardiac output while avoiding blood contact that occurs with other assist methods.

Development of magnetic bearing system for a new third-generation blood pump

A magnetic bearing system is a crucial component in a third-generation blood pump, particularly when we consider aspects such as system durability and blood compatibility. Many factors such as efficiency, occupying volume, hemodynamic stability in the flow path, mechanical stability, and stiffness need to be considered for the use of a magnetic bearing system in a third-generation blood pump, and a number of studies have been conducted to develop novel magnetic bearing design for better handling of these factors. In this study, we developed and evaluated a new magnetic bearing system having a motor for a new third-generation blood pump. This magnetic bearing system consists of a magnetic levitation compartment and a brushless direct current (BLDC) motor compartment. The active-control degree of freedom is one; this control is used for controlling the levitation in the axial direction. The levitation in the radial direction has a passive magnetic levitation structure. In order to improve the system efficiency, we separated the magnetic circuit for axial levitation by using a magnetic circuit for motor drive. Each magnetic circuit in the bearing system was designed to have a minimum gap by placing mechanical parts, such as the impeller blades, outside the circuit. A custom-designed noncontact gap sensor was used for minimizing the system volume. We fabricated an experimental prototype of the proposed magnetic bearing system and evaluated its performance by a control system using the Matlab xPC Target system. The noncontact gap sensor was an eddy current gap sensor with an outer diameter of 2.38 mm, thickness of 0.88 mm, and resolution of 5 µm. The BLDC motor compartment was designed to have an outer diameter of 20 mm, length of 28.75 mm, and power of 4.5 W. It exhibited a torque of 8.6 mNm at 5000 rpm. The entire bearing system, including the motor and the sensor, had an outer diameter of 22 mm and a length of 97 mm. The prototype exhibited sufficient levitation performance in the stop state and the rotation state with a gap of 0.2 mm between the rotor and the stator. The system had a steady position error of 0.01 µm in the stop state and a position error of 0.02 µm at a rotational speed of 5000 rpm; the current consumption rates were 0.15 A and 0.17 A in the stop state and the rotation state, respectively. In summary, we developed and evaluated a unique magnetic bearing system with an integrated motor. We believe that our design will be an important basis for the further development of the design of an entire third-generation blood pump system.

In Vitro and In Vivo Performance Evaluation of the Second Developmental Version of the PediaFlow Pediatric Ventricular Assist Device

Ventricular assist devices (VADs) have significantly impacted the treatment of adult cardiac failure, but few options exist for pediatric patients. This has motivated our group to develop an implantable magnetically levitated rotodynamic VAD (PediaFlow®) for 3-20 kg patients. The second prototype design of the PediaFlow (PF2) is 56% smaller than earlier prototypes, and achieves 0.5-1.5 L/min blood flow rates. In vitro hemodynamic performance and hemolysis testing were performed with analog blood and whole ovine blood, respectively. In vivo evaluation was performed in an ovine model to evaluate hemocompatibility and end-organ function. The in vitro normalized index of hemolysis was 0.05-0.14 g/L over the specified operating range. In vivo performance was satisfactory for two of the three implanted animals. A mechanical defect caused early termination at 17 days of the first in vivo study, but two subsequent implants proceeded without complication and electively terminated at 30 and 70 days. Serum chemistries and plasma free hemoglobin were within normal limits. Gross necropsy revealed small, subclinical infarctions in the kidneys of the 30 and 70 day animals (confirmed by histopathology). The results of these experiments, particularly the biocompatibility demonstrated in vivo encourage further development of a miniature magnetically levitated VAD for the pediatric population. Ongoing work including further reduction of size will lead to a design freeze in preparation for of clinical trials.