Hemolysis Resulting From Surface Roughness Under Shear Flow Conditions Using a Rotational Shear Stressor

A new strategy to prevent biofilm and clot formation in medical devices: The use of atmospheric non-thermal plasma assisted deposition of silver-based nanostructured coatings

In industrialized countries, health care associated infections, the fourth leading cause of disease, are a major health issue. At least half of all cases of nosocomial infections are associated with medical devices. Antibacterial coatings arise as an important approach to restrict the nosocomial infection rate without side effects and the development of antibiotic resistance. Beside nosocomial infections, clot formation affects cardiovascular medical devices and central venous catheters implants. In order to reduce and prevent such infection, we develop a plasma-assisted process for the deposition of nanostructured functional coatings on flat substrates and mini catheters. Silver nanoparticles (Ag NPs) are synthesized exploiting in-flight plasma-droplet reactions and are embedded in an organic coating deposited through hexamethyldisiloxane (HMDSO) plasma assisted polymerization. Coating stability upon liquid immersion and ethylene oxide (EtO) sterilization is assessed through chemical and morphological analysis carried out by means of Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). In the perspective of future clinical application, an in vitro analysis of anti-biofilm effect has been done. Moreover, we employed a murine model of catheter-associated infection which further highlighted the performance of Ag nanostructured films in counteract biofilm formation. The anti-clot performances coupled by haemo- and cytocompatibility assays have also been performed.

The influence of surface roughness on the damage of von Willebrand Factor under shear flow condition

Despite technological advances in mechanical circulatory support devices to treat end-stage heart failure, blood damage induced by non-physiological shear stress in operation often triggered clinical hemocompatibility complications. The loss of high molecular weight von Willebrand Factor (HMW-VWF) has been considered as an essential cause of gastrointestinal bleeding. In addition to the mechanics factors, interface factors may also affect blood damage, especially the surface characteristics. In this study, the effect of surface roughness on VWF damage under flow condition was investigated. A roller pump circulation experimental platform with a roughness embedded sample chamber was constructed to provide blood shearing flow condition. VWF molecular weight analysis, VWF antigen (VWF-Ag) concentration assay, and VWF ristocetin cofactor activity (VWF-Rico) assay were performed on the sheared blood samples. These variables are the main functional indicators of VWF. It was found that the surface roughness induced VWF damage is mainly caused by the loss of HMW-VWF rather than reducing the total amount of VWF. The threshold value of surface roughness for a rapid increase in the degradation of HMW-VWF under low flow rate was obtained between Ra 0.4 and 0.6 μm, which was smaller than the threshold for hemolysis. Our findings indicated that VWF is more sensitive to the interface factor of surface roughness than red blood cells, thus has a higher requirement for blood pump design. It could provide reference for the material design and processing in developing mechanical circulatory support devices.

Quantitative investigation of platelet aggregation under high shear force for anti-platelet aggregation in vitro tests

Blood pumps are often used for hemofiltration in patients with renal failure. To design effective centrifugal blood pumps for hemofiltration, it is important to suppress clogging caused by platelet aggregation. However, the optimal conditions for conducting anti-platelet aggregation tests in vitro have not yet been established. This study aimed to quantify the effect of the shear loading value and shear loading time on platelet aggregation and determine the optimal conditions for anti-platelet aggregation testing in vitro. To quantitatively evaluate platelet aggregation in terms of the negative logarithm-platelet aggregation threshold index (NL-PATI), which reflects the propensity of residual platelets to aggregate after shear loading, the following parameters were examined: blood collection method (collected from porcine vein using a syringe or collected from a slaughterhouse), type of anticoagulant (sodium citrate or heparin), shear rate, and shear time. The results showed that platelet aggregation in porcine blood increased under a high shear load applied at shear rates of approximately 20,000 s^-1 or higher for 30 s. Platelet aggregation propensity was 2-3 times higher in heparin-anticoagulated blood than in sodium citrate-anticoagulated blood. Moreover, platelet aggregation was 1.5-2 times more in blood collected from the slaughterhouse than in syringe-collected blood. Testing with an integrated shear time of 30 s or less in relation to the total blood volume may be effective for conducting in vitro circulation experiments using hemofiltration blood pumps. The conditions established in this study may be useful for hemocompatibility testing of cardiovascular devices based on NL-PATI.

In Vitro Testing and Comparison of Additively Manufactured Polymer Impellers for the CentriMag Blood Pump

Additive manufacturing (AM) is an effective tool for accelerating knowledge gain in development processes, as it enables the production of complex prototypes at low cost and with short lead times. In the development of mechanical circulatory support, the use of cheap polymer-based AM techniques for prototype manufacturing allows more design variations to be tested, promoting a better understanding of the respective system and its optimization parameters. Here, we compare four commonly used AM processes for polymers with respect to manufacturing accuracy, surface roughness, and shape fidelity in an aqueous environment. Impeller replicas of the CentriMag blood pump were manufactured with each process and integrated into original pump housings. The assemblies were tested for hydraulic properties and hemolysis in reference to the commercially available pump. Computational fluid dynamic simulations were carried out to support the transfer of the results to other applications. In hydraulic testing, the deviation in pressure head and motor current of all additively manufactured replicas from the reference pump remained below 2% over the entire operating range of the pump. In contrast, significant deviations of up to 620% were observed in hemolysis testing. Only the replicas produced by stereolithography showed a nonsignificant deviation from the reference pump, which we attribute to the low surface roughness of parts manufactured thereby. The results suggest that there is a flow-dependent threshold of roughness above which a surface strongly contributes to cell lysis by promoting a hydraulically rough boundary flow.

Hemolysis and von Willebrand factor degradation in mechanical shuttle shear flow tester

Chronic blood trauma caused by the shear stresses generated by mechanical circulatory support (MCS) systems is one of the major concerns to be considered during the development of ventricular assist devices. Large multimers with high-molecular-weight von Willebrand factor (VWF) are extended by the fluid forces in a shear flow and are cleaved by ADAMTS13. Since the mechanical revolving motions in artificial MCSs induce cleavage in large VWF multimers, nonsurgical bleeding associated with the MCS is likely to occur after mechanical hemodynamic support. In this study, the shear stress (~ 600 Pa) and exposure time related to hemolysis and VWF degradation were investigated using a newly designed mechanical shuttle shear flow tester. The device consisted of a pair of cylinders facing the test section of a small-sized pipe; both the cylinders were connected to composite mechanical heads with a sliding-sleeve structure for axial separation during the withdrawing motion. The influence of exposure time, in terms of the number of stress cycles, on hemolysis and VWF degradation was confirmed using fresh goat blood, and the differences in the rates of dissipation of the multimers were established. The plasma-free hemoglobin levels showed a logarithmic increase corresponding to the number of cycles, and the dissipation of large VWF multimers occurred within a few seconds under high shear stress flow conditions.

Ratio of surface roughness to flow scale as additional parameter for shear-induced hemolysis

BACKGROUND

In addition to the conventional knowledge that shear stress and its exposure time should have a large impact on hemolysis, it became obvious through Dr. Maruyama's study that surface roughness would be the additional factor for high shear-induced hemolysis. Concerning this new information, we hypothesized that the ratio of surface roughness to the flow scale should play a role as the additional factor for shear-induced hemolysis. The purpose of this study was to develop a constant shear generator as the method to provide a controlled shear flow field with the combination between the controlled surface roughness and the flow scale to the blood cells. Its preliminary application was to validate our hypothesis.

METHODS

We prototyped the constant shear stress generator with the cylindrical cone-cup structure made from the acrylic material. This chamber had 3 flow scales of 1.00, 1.25, and 1.5 mm according to the change of the inner stationary cone, at which the surface roughness was distributed into the several levels between 0.14 and 0.92 micrometers in arithmetic average roughness. Using this shear chamber, we examined what effect the flow scale and the surface roughness had on hemolysis.

RESULTS

Our experimental data showed the tendency of a positive correlation between the ratio of surface roughness to the flow scale and the induced hemolysis levels, validating our hypothesis.

CONCLUSIONS

The ratio of the surface roughness to the flow scale should be the additional parameter for shear-induced hemolysis.

Study of flow-induced hemolysis using novel Couette-type blood-shearing devices

To assist the development and application of blood-contacting medical devices, two novel flow-through Couette-type blood-shearing devices have been developed to study the quantitative relationship between blood damage indexes and flow-dependent parameters. One device is an axial flow-through Couette-type device supported by a pair of pin bearings adapted from the adult Jarvik 2000 blood pump. The other is a centrifugal flow-through Couette-type device supported with magnetic bearings adapted from the CentriMag blood pump. In both devices, a rotor spindle was used to replace the original impeller blades so that a small gap was created between the housing and the rotating spindle surface. Computational fluid dynamics simulations have shown that a uniform, high shear stress region can be generated inside the small gap while the shear stresses elsewhere are relatively low. The possibility of secondary blood damage caused by mechanical seals was eliminated due to the use of a magnetic rotor system. Blood flow through the gap was driven by an externally pressurized reservoir. By adjusting the rotational speed and blood flow rate, shear-induced hemolysis was quantified at a matrix of exposure time (0.039 to 1.48 s) and shear stress (50 to 320 Pa). All of the experiments were conducted at room temperature using heparinized ovine blood with a hematocrit value of 30%. The measured hemolysis levels were much lower than those published in the literature, and the overestimation of those earlier studies may be attributable to device-related secondary blood-damaging effects. A new set of coefficients for the power law model was derived from the regression of the experimental data.