Numerical design and experimental hydraulic testing of an axial flow ventricular assist device for infants and children

Novel hybrid total artificial heart with integrated oxygenator

There continues to be an unmet therapeutic need for an alternative treatment strategy for respiratory distress and lung disease. We are developing a portable cardiopulmonary support system that integrates an implantable oxygenator with a hybrid, dual-support, continuous-flow total artificial heart (TAH). The TAH has a centrifugal flow pump that is rotating about an axial flow pump. By attaching the hollow fiber bundle of the oxygenator to the base of the TAH, we establish a new cardiopulmonary support technology that permits a patient to be ambulatory during usage. In this study, we investigated the design and improvement of the blood flow pathway from the inflow-to-outflow of four oxygenators using a mathematical model and computational fluid dynamics (CFD). Pressure loss and gas transport through diffusion were examined to assess oxygenator design. The oxygenator designs led to a resistance-driven pressure loss range of less than 35 mmHg for flow rates of 1-7 L/min. All of the designs met requirements. The configuration having an outside-to-inside blood flow direction was found to have higher oxygen transport. Based on this advantageous flow direction, two designs (Model 1 and 3) were then integrated with the axial-flow impeller of the TAH for simulation. Flow rates of 1-7 L/min and speeds of 10,000-16,000 RPM were analyzed. Blood damage studies were performed, and Model 1 demonstrated the lowest potential for hemolysis. Future work will focus on developing and testing a physical prototype for integration into the new cardiopulmonary assist system.

Development of the Centrifugal Blood Pump for a Hybrid Continuous Flow Pediatric Total Artificial Heart: Model, Make, Measure

Clinically-available blood pumps and total artificial hearts for pediatric patients continue to lag well behind those developed for adults. We are developing a hybrid, continuous-flow, magnetically levitated, pediatric total artificial heart (TAH). The hybrid TAH design integrates both an axial and centrifugal blood pump within a single, compact housing. The centrifugal pump rotates around the separate axial pump domain, and both impellers rotate around a common central axis. Here, we concentrate our development effort on the centrifugal blood pump by performing computational fluid dynamics (CFD) analysis of the blood flow through the pump. We also conducted transient CFD analyses (quasi-steady and transient rotational sliding interfaces) to assess the pump's dynamic performance conditions. Through modeling, we estimated the pressure generation, scalar stress levels, and fluid forces exerted on the magnetically levitated impellers. To further the development of the centrifugal pump, we also built magnetically-supported prototypes and tested these in an in vitro hydraulic flow loop and via 4-h blood bag hemolytic studies (n = 6) using bovine blood. The magnetically levitated centrifugal prototype delivered 0–6.75 L/min at 0–182 mmHg for 2,750–4,250 RPM. Computations predicted lower pressure-flow performance results than measured by testing; axial and radial fluid forces were found to be <3 N, and mechanical power usage was predicted to be <5 Watts. Blood damage indices (power law weighted exposure time and scalar stress) were <2%. All data trends followed expectations for the centrifugal pump design. Six peaks in the pressure rise were observed in the quasi-steady and transient simulations, correlating to the blade passage frequency of the 6-bladed impeller. The average N.I.H value (n = 6) was determined to be 0.09 ± 0.02 g/100 L, which is higher than desired and must be addressed through design improvement. These data serve as a strong foundation to build upon in the next development phase, whereby we will integrate the axial flow pump component.

Comparison between Single-Phase Flow Simulation and Multiphase Flow Simulation of Patient-Specific Total Cavopulmonary Connection Structures Assisted by a Rotationally Symmetric Blood Pump

To accurately assess the hemolysis risk of the ventricular assist device, this paper proposed a cell destruction model and the corresponding evaluation parameters based on multiphase flow. The single-phase flow and multiphase flow in two patient-specific total cavopulmonary connection structures assisted by a rotationally symmetric blood pump (pump-TCPC) were simulated. Then, single-phase and multiphase cell destruction models were used to evaluate the hemolysis risk. The results of both cell destruction models indicated that the hemolysis risk in the straight pump-TCPC model was lower than that in the curved pump-TCPC model. However, the average and maximum values of the multiphase flow blood damage index (mBDI) were smaller than those of the single-phase flow blood damage index (BDI), but the average and maximum values of the multiphase flow particle residence time (mPRT) were larger than those of the single-phase flow particle residence time (PRT). This study proved that the multiphase flow method can be used to simulate the mechanical behavior of red blood cells (RBCs) and white blood cells (WBCs) in a complex flow field and the multiphase flow cell destruction model had smaller estimates of the impact shear stress.

Integrated long-term multifunctional pediatric mechanical circulatory assist device

There continues to be limited, viable ventricular assist device technology options to support the dysfunctional states of pediatric heart failure. To address this need, we are developing a magnetically suspended, versatile pumping technology that uniquely integrates two blood pumps in a series configuration within a single device housing. This device enables operational switching from the usage of one pump to another as needed for clinical management or to support growth and development of the pediatric patient. Here, we present the initial design where we conducted a virtual fit study, the Taguchi Design Optimization Method, iterative design to develop pump geometries. Computational tools were used to estimate the pressure generation, capacity delivery, hydraulic efficiency, fluid stress levels, exposure time to stresses, blood damage index, and fluid forces on the impellers. Prototypes of the pumps were tested in a flow loop using a water-glycerin solution. Both designs demonstrated the capability to generate target pressures and flows. Blood damage estimations were below threshold levels and achieved design requirements; however, maximum scalar stress levels were above the target limit. Radial and axial forces were less than 1 N and 10 N, respectively. The performance data trends for physical prototypes correlated with theoretical expectations. The centrifugal prototype was able to generate slightly higher pressure rises than numerical predictions. In contrast, the axial prototype outperformed the computational studies. Experimental data were both repeatable and reproducible. The findings from this research are promising, and development will continue.

Cardiac Magnetic Resonance Imaging of Mechanical Cavopulmonary Assistance

Mechanical circulatory support (MCS) options are limited for patients with dysfunctional single ventricle physiology. To address this unmet clinical need, we are developing an axial-flow blood pump to provide mechanical assistance to the cavopulmonary circulation. In this study, we investigate the use of high-resolution cardiac magnetic resonance imaging (MRI) to visualize the complex fluid flow conditions of mechanical circulatory assist in two patient-specific Fontan anatomies. A three-bladed axial-flow impeller coupled to a supportive cage with a four-bladed diffuser was positioned in the inferior vena cava (IVC) of each Fontan anatomy. Cardiac magnetic resonance (CMR) imaging and power efficiency studies were conducted at physiologic relevant parameters with cardiac outputs of 2, 3, and 4 L/min with impeller rotational speeds of 2000 and 4000 rpm. The axial-flow impeller was able to generate improved flow in the total cavopulmonary connection (TCPC). The higher rotational speed was able to redistribute flow in the TCPC anastomosis aiding in removing stagnant blood. No retrograde flow was observed or measured in the superior vena cava (SVC). As an extension of the CMR data, a scalar stress analysis was performed on both models and found a maximum scalar stress of approximately 42 Pa for both patient anatomies. The power efficiency experiments demonstrated a maximum energy gain of 8.6 mW for TCPC Anatomy 1 and 12.58 mW for TCPC Anatomy 2 for a flow rate of 4 L/min and at 4000 rpm. These findings support the continued development of axial blood pumps for mechanical cavopulmonary assist.

Mechanical axial flow blood pump to support cavopulmonary circulation

We are developing a collapsible, percutaneously inserted, axial flow blood pump to support the cavopulmonary circulation in infants with a failing single ventricle physiology. An initial design of the impeller for this axial flow blood pump was performed using computational fluid dynamics analysis, including pressure-flow characteristics, scalar stress estimations, blood damage indices, and fluid force predictions. A plastic prototype was constructed for hydraulic performance testing, and these experimental results were compared with the numerical predictions. The numerical predictions and experimental findings of the pump performance demonstrated a pressure generation of 2–16 mm Hg for 50–750 ml/min over 5,500–7,500 RPM with deviation found at lower rotational speeds. The axial fluid forces remained below 0.1 N, and the radial fluid forces were determined to be virtually zero due to the centered impeller case. The scalar stress levels remained below 250 Pa for all operating conditions. Blood damage analysis yielded a mean residence time of the released particles, which was found to be less than 0.4 seconds for both flow rates that were examined, and a maximum residence time was determined to be less than 0.8 seconds. We are in the process of designing a cage with hydrodynamically shaped filament blades to act as a diffuser and optimizing the impeller blade shape to reduce the flow vorticity at the pump outlet. This blood pump will improve the clinical treatment of patients with failing Fontan physiology and provide a unique catheter-based therapeutic approach as a bridge to recovery or transplantation.

Hybrid Continuous-Flow Total Artificial Heart

Clinical studies using total artificial hearts (TAHs) have demonstrated that pediatric and adult patients derive quality-of-life benefits from this form of therapy. Two clinically-approved TAHs and other pumps under development, however, have design challenges and limitations, including thromboembolic events, neurologic impairment, infection risk due to large size and percutaneous drivelines, and lack of ambulation, to name a few. To address these limitations, we are developing a hybrid-design, continuous-flow, implantable or extracorporeal, magnetically-levitated TAH for pediatric and adult patients with heart failure. This TAH has only two moving parts: an axial impeller for the pulmonary circulation and a centrifugal impeller for the systemic circulation. This device will utilize the latest generation of magnetic bearing technology. Initial geometries were established using pump design equations, and computational modeling provided insight into pump performance. The designs were the basis for prototype manufacturing and hydraulic testing. The study results demonstrate that the TAH is capable of delivering target blood flow rates of 1-6.5 L/min with pressure rises of 1-92 mm Hg for the pulmonary circulation and 24-150 mm Hg for the systemic circulation at 1500-10 000 rpm. This initial design of the TAH was successful and serves as the foundation to continue its development as a novel, more compact, nonthrombogenic, and effective therapeutic alternative for infants, children, adolescents, and adults with heart failure.

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.

NUMERICAL STUDIES OF AN AXIAL FLOW BLOOD PUMP WITH DIFFERENT DIFFUSER DESIGNS

Most axial flow blood pumps basically consist of a straightener, an impeller, and a diffuser. The diffuser plays a very important role in the performance of the pump to provide an adequate pressure head and to increase the hydraulic efficiency. During the development of an axial flow blood pump, irregular flow field near the diffuser hub is not desirable as it may induce thrombosis. In order to avoid this phenomenon, two approaches were adopted. In the first approach, the number of the diffuser blades was increased from three (B3, baseline model) to five (B5 model). It was observed that the flow field was improved, but the irregular flow patterns were not completely eliminated. In the second approach, we detached the blades from the diffuser hub (B3C2 model), which was integrated and rotated with the impeller hub. It was found that the rotary diffuser hub significantly improved the flow field, especially near the diffuser hub. Besides the detailed flow fields, the hydraulic and hematologic performances at various flow conditions were also estimated using computational fluid dynamics (CFD). Although each design has its own advantages and disadvantages, the B5 model was superior based on a comparative overview.

Controlled pitch-adjustment of impeller blades for an intravascular blood pump

Thousands of mechanical blood pumps are currently providing circulatory support, and the incidence of their use continues to increase each year. As the use of blood pumps becomes more pervasive in the treatment of those patients with congestive heart failure, critical advances in design features to address known limitations and the integration of novel technologies become more imperative. To advance the current state-of-the-art in blood pump design, this study investigates the inclusion of pitch-adjusting blade features in intravascular blood pumps as a means to increase energy transfer; an approach not explored to date. A flexible impeller prototype was constructed with a configuration to allow for a variable range of twisted blade geometries of 60-250°. Hydraulic experiments using a blood analog fluid were conducted to characterize the pressure-flow performance for each of these twisted positions. The flexible, twisted impeller was able to produce 1-25 mmHg for 0.5-4 L/min at rotational speeds of 5,000-8,000 RPM. For a given twisted position, the pressure rise was found to decrease as a function of increasing flow rate, as expected. Generally, a steady increase in the pressure rise was observed as a function of higher twisted degrees for a constant rotational speed. Higher rotational speeds for a specific twisted impeller configuration resulted in a more substantial pressure generation. The findings of this study support the continued exploration of this unique design approach in the development of intravascular blood pumps.

Twisted cardiovascular cages for intravascular axial flow blood pumps to support the Fontan physiology

Failing single ventricle physiology represents an ongoing challenge in mechanical assist device development, requiring pressure augmentation in the cavopulmonary circuit, reduction of systemic venous pressure, and increased cardiac output to achieve hemodynamic stabilization. To meet these requirements, we are developing a percutaneously-placed, axial flow blood pump to support ailing single ventricle physiology in adolescents and adults. We have modified the outer cage of the device to serve as both a protective and functional design component. This study examined the performance of 3 cage geometries with varying directions of filament twist using numerical simulations and hydraulic experiments. All 3 cage and pump models performed in acceptable ranges to support Fontan patients. The cage design employing filaments that are twisted in the opposite direction to the impeller blades and in the direction of the diffuser blades (against-with) demonstrated superior performance by generating a pressure rise range of 5-38 mmHg of flow rates of 0.5-6 l/min at rotational speeds of 5000-7000 rpm. The blood damage indices for all of the cages were found to be well below 2%, and the scalar stress levels were below 200 Pa. This study represents ongoing progress in the development of the impeller and cage assembly. Validation of the results will continue in experiments with blood bag evaluation as well as by particle image velocimetry measurements.

The use of computational fluid dynamics in the development of ventricular assist devices

Progress in the field of prosthetic cardiovascular devices has significantly contributed to the rapid advancements in cardiac therapy during the last four decades. The concept of mechanical circulatory assistance was established with the first successful clinical use of heart-lung machines for cardiopulmonary bypass. Since then a variety of devices have been developed to replace or assist diseased components of the cardiovascular system. Ventricular assist devices (VADs) are basically mechanical pumps designed to augment or replace the function of one or more chambers of the failing heart. Computational Fluid Dynamics (CFD) is an attractive tool in the development process of VADs, allowing numerous different designs to be characterized for their functional performance virtually, for a wide range of operating conditions, without the physical device being fabricated. However, VADs operate in a flow regime which is traditionally difficult to simulate; the transitional region at the boundary of laminar and turbulent flow. Hence different methods have been used and the best approach is debatable. In addition to these fundamental fluid dynamic issues, blood consists of biological cells. Device-induced biological complications are a serious consequence of VAD use. The complications include blood damage (haemolysis, blood cell activation), thrombosis and emboli. Patients are required to take anticoagulation medication constantly which may cause bleeding. Despite many efforts blood damage models have still not been implemented satisfactorily into numerical analysis of VADs, which severely undermines the full potential of CFD. This paper reviews the current state of the art CFD for analysis of blood pumps, including a practical critical review of the studies to date, which should help device designers choose the most appropriate methods; a summary of blood damage models and the difficulties in implementing them into CFD; and current gaps in knowledge and areas for future work.

Numerical, hydraulic, and hemolytic evaluation of an intravascular axial flow blood pump to mechanically support Fontan patients

Currently available mechanical circulatory support systems are limited for adolescent and adult patients with a Fontan physiology. To address this growing need, we are developing a collapsible, percutaneously-inserted, axial flow blood pump to support the cavopulmonary circulation in Fontan patients. During the first phase of development, the design and experimental evaluation of an axial flow blood pump was performed. We completed numerical modeling of the pump using computational fluid dynamics analysis, hydraulic testing of a plastic pump prototype, and blood bag experiments (n=7) to measure the levels of hemolysis produced by the pump. Statistical analyses using regression were performed. The prototype with a 4-bladed impeller generated a pressure rise of 2-30 mmHg with a flow rate of 0.5-4 L/min for 3000-6000 RPM. A comparison of the experimental performance data to the numerical predictions demonstrated an excellent agreement with a maximum deviation being less than 6%. A linear increase in the plasma-free hemoglobin (pfHb) levels during the 6-h experiments was found, as desired. The maximum pfHb level was measured to be 21 mg/dL, and the average normalized index of hemolysis was determined to be 0.0097 g/100 L for all experiments. The hydraulic performance of the prototype and level of hemolysis are indicative of significant progress in the design of this blood pump. These results support the continued development of this intravascular pump as a bridge-to-transplant, bridge-to-recovery, bridge-to-hemodynamic stability, or bridge-to-surgical reconstruction for Fontan patients.

Estimation of changes in dynamic hydraulic force in a magnetically suspended centrifugal blood pump with transient computational fluid dynamics analysis

The effect of the hydraulic force on magnetically levitated (maglev) pumps should be studied carefully to improve the suspension performance and the reliability of the pumps. A maglev centrifugal pump, developed at Ibaraki University, was modeled with 926 376 hexahedral elements for computational fluid dynamics (CFD) analyses. The pump has a fully open six-vane impeller with a diameter of 72.5 mm. A self-bearing motor suspends the impeller in the radial direction. The maximum pressure head and flow rate were 250 mmHg and 14 l/min, respectively. First, a steady-state analysis was performed using commercial code STAR-CD to confirm the model's suitability by comparing the results with the real pump performance. Second, transient analysis was performed to estimate the hydraulic force on the levitated impeller. The impeller was rotated in steps of 1 degrees using a sliding mesh. The force around the impeller was integrated at every step. The transient analysis revealed that the direction of the radial force changed dynamically as the vane's position changed relative to the outlet port during one circulation, and the magnitude of this force was about 1 N. The current maglev pump has sufficient performance to counteract this hydraulic force. Transient CFD analysis is not only useful for observing dynamic flow conditions in a centrifugal pump but is also effective for obtaining information about the levitation dynamics of a maglev pump.

CFD analysis of a Mag-Lev ventricular assist device for infants and children: fourth generation design

Thousands of pediatric patients suffering from heart failure would benefit from longer-term mechanical circulatory support. There are, however, few support systems available in the United States as viable mechanical assist alternatives for these patients. Therefore, we have designed and developed an axial flow pediatric ventricular assist device (PVAD) with an impeller that is fully suspended by magnetic bearings. This blood pump is designed to generate 0.5-4 L/min for pressure rises of 50-95 mm Hg over 6,000-9,000 rpm. We have performed four major design iterations. Building upon the third design phase, we made improvements to create the PVAD4 model. Numerical simulations of the PVAD4 under steady flow simulations were performed to compare the predictions of the latest PVAD4 model to the earlier PVAD3 design. The PVAD4 design resulted in lower fluid stress levels and an increase in pressure generation. A blood damage analysis was also completed. As compared with the earlier PVAD3 design, the damage analysis of the PVAD4 indicated a reduction in the mean and maximum damage index for the new design. All of these numerical findings are encouraging and demonstrate progress toward achieving a superior pump design.