Biomaterials for rotary blood pumps

Optimization design of semi-open impeller based on thrombogenicity in a blood pump

BACKGROUND

Blood clots are composed of aggregated fibrin and platelets, and thrombosis is the body's natural response to repairing injured blood vessels or stopping bleeding. However, when this process is activated abnormally, such as in a mechanical blood pump, it can lead to excessive thrombus formation. Therefore, how to avoid or reduce the probability of thrombus formation is an important indicator of the stable operation of a blood pump.

METHODS

In this paper, Lagrangian particle tracking trajectories are simulated to study platelet transport in a blood pump. The design of the thrombus blood pump was optimized using an orthogonal design method based on three factors: inlet angle, outlet angle, and blade number. The effect of blood pump pressure, rotational speed, impeller outlet angle, inlet angle, and number of blades on thrombus formation was analysed using Fluent software. The thrombogenic potential was derived by analyzing the trajectory and flow parameters of platelet particles in the blood pump, as well as the statistical parameters of residence time and stress accumulation thrombus in the platelet pump.

RESULTS

When the impeller inlet angle is 30°, the outlet angle is 20°, and the number of blades is 6, the probability of thrombus formation is minimized in the orthogonal design method, aligning with the requirements for blood pump performance.

CONCLUSIONS

These design parameters serve as a numerical guideline for optimizing the geometry of the semi-open impeller in blood pumps and provide a theoretical foundation for subsequent in vitro experiments.

Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy

Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient-an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges.

Blood flow in a continuous flow ventricular assist device

A numerical analysis was performed to predict the shear stresses, flow rates, and the velocity profiles in a continuous flow ventricular assist device, the CFVAD3. The problem was modeled as a rotating disk over a stationary disk. A variety of clearances was tested for the CFVAD3 coupled with a range of rotational speeds and pressure gradients. Velocity fields were generated using solutions obtained with FLOW3D software (AEA Technology, Pittsburgh, PA, U.S.A.) Analysis of these solutions shows that the pressure differential effect has a stronger influence on the flow than the rotational effect of the impeller Ekman layer. The predicted shear stresses reflect these changes in the volume flow rates and the speeds shown in the velocity profiles. Based on the predictions of the software, the optimum clearance and rotational speed were chosen. The conclusion is that a speed in the range of 2,200-2,400 rpm should be chosen depending on the efficiency of the pump.