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Valtchanov H, Cecere R, Atkinson LTJ, Mongrain R. Simulation of the effect of hemolysis on thrombosis in blood-contacting medical devices. Med Eng Phys 2024; 131:104218. [PMID: 39284659 DOI: 10.1016/j.medengphy.2024.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/22/2024] [Accepted: 07/31/2024] [Indexed: 09/19/2024]
Abstract
Heart failure, broadly characterized by the gradual decline of the ability of the heart to maintain adequate blood flow throughout the body's vascular network of veins and arteries, is one of the leading causes of death worldwide. Mechanical Circulatory Support is one of the few available alternative interventions for late-stage heart failure with reduced ejection fraction. A ventricular assist device is surgically implanted and connected to the left and or right heart ventricles to provide additional bloodflow, off-loading the work required by the heart to maintain circulation. Modern mechanical circulatory support devices generate non-physiological flow conditions that can lead to the damage and rupture of blood cells (hemolysis), and the formation of blood clots (thrombosis), which pose severe health risks to the patient. It is essential to improve prediction tools for blood damage to reduce the risk of hemolysis and thrombosis. A simulation-based approach examines the interaction between hemolysis and thrombosis. Incompressible finite-volume computational fluid dynamics simulations are executed on an open-hub axial flow ventricular assist device. A continuum model of thrombosis and the intrinsic coagulation process is extended to include the effect of hemolysis. The model accounts for the effect of activation of platelets by shear stress, paracrine signaling, adhesion, and hemoglobin and ADP released during hemolysis. The effect of hemolysis with thrombosis is modelled by accounting for the hyper-adhesivity of von-Willebrand Factor on extracellular hemoglobin, and the increased rate of platelet activation induced by ADP release. Thrombosis is assessed at varying inflow rates and rotor speeds, and cases are executed where thrombosis is affected by ADP release and Hb-induced hyper-adhesivity. It is found that there is a non-negligible effect from hemolysis on thrombosis across a range of rotor speeds, and that hyperadhesivity plays a dominant role in thrombus formation in the presence of hemolysis.
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Affiliation(s)
- H Valtchanov
- Department of Mechanical Engineering, McGill University, Montreal, QC, Canada
| | - R Cecere
- Division of Cardiac Surgery, McGill University Health Center, Montreal, QC, Canada
| | - L T J Atkinson
- Cardiac Surgery, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R Mongrain
- Department of Mechanical Engineering, McGill University, Montreal, QC, Canada
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2
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Su B, Palahnuk H, Harbaugh T, Rizk E, Hazard W, Chan A, Bernstein J, Weinsaft JW, Manning KB. Numerical Study on the Impact of Central Venous Catheter Placement on Blood Flow in the Cavo-Atrial Junction. Ann Biomed Eng 2024; 52:1378-1392. [PMID: 38407724 DOI: 10.1007/s10439-024-03463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
An in silico study is performed to investigate fluid dynamic effects of central venous catheter (CVC) placement within patient-specific cavo-atrial junctions. Prior studies show the CVC infusing a liquid, but this study focuses on the placement without any liquid emerging from the CVC. A 7 or 15-French double-lumen CVC is placed virtually in two patient-specific models; the CVC tip location is altered to understand its effect on the venous flow field. Results show that the CVC impact is trivial on flow in the superior vena cava when the catheter-to-vein ratio ranges from 0.15 to 0.33. Results further demonstrate that when the CVC tip is directly in the right atrium, flow vortices in the right atrium result in elevated wall shear stress near the tip hole. A recirculation region characterizes a spatially variable flow field inside the CVC side hole. Furthermore, flow stagnation is present near the internal side hole corners but an elevated wall shear stress near the curvature of the side hole's exit. These results suggest that optimal CVC tip location is within the superior vena cava, so as to lower the potential for platelet activation due to elevated shear stresses and that CVC geometry and location depth in the central vein significantly influences the local CVC fluid dynamics. A thrombosis model also shows thrombus formation at the side hole and tip hole. After modifying the catheter design, the hemodynamics change, which alter thrombus formation. Future studies are warranted to study CVC design and placement location in an effort to minimize CVC-induced thrombosis incidence.
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Affiliation(s)
- Boyang Su
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Hannah Palahnuk
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Thaddeus Harbaugh
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Elias Rizk
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Will Hazard
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Angel Chan
- Department of Medicine (Cardiology), Weill Cornell College, New York, NY, USA
- Department of Medicine (Cardiology), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Bernstein
- Division of Pediatric Hematology/Oncology, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Cardiology), Weill Cornell College, New York, NY, USA
- Department of Medicine (Cardiology), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology (Cardiothoracic Imaging), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA.
- Department of Surgery, Penn State College of Medicine, Hershey, PA, USA.
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3
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Wang K, Armour CH, Gibbs RGJ, Xu XY. A numerical study of the effect of thrombus breakdown on predicted thrombus formation and growth. Biomech Model Mechanobiol 2024; 23:61-71. [PMID: 37566172 PMCID: PMC10901920 DOI: 10.1007/s10237-023-01757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
Thrombosis is a complex biological process which involves many biochemical reactions and is influenced by blood flow. Various computational models have been developed to simulate natural thrombosis in diseases such as aortic dissection (AD), and device-induced thrombosis in blood-contacting biomedical devices. While most hemodynamics-based models consider the role of low shear stress in the initiation and growth of thrombus, they often ignore the effect of thrombus breakdown induced by elevated shear stress. In this study, a new shear stress-induced thrombus breakdown function is proposed and implemented in our previously published thrombosis model. The performance of the refined model is assessed by quantitative comparison with experimental data on thrombus formation in a backward-facing step geometry, and qualitative comparison with in vivo data obtained from an AD patient. Our results show that incorporating thrombus breakdown improves accuracy in predicted thrombus volume and captures the same pattern of thrombus evolution as measured experimentally and in vivo. In the backward-facing step geometry, thrombus breakdown impedes growth over the step and downstream, allowing a stable thrombus to be reached more quickly. Moreover, the predicted thrombus volume, height and length are in better agreement with the experimental measurements compared to the original model which does not consider thrombus breakdown. In the patient-specific AD, the refined model outperforms the original model in predicting the extent and location of thrombosis. In conclusion, the effect of thrombus breakdown is not negligible and should be included in computational models of thrombosis.
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Affiliation(s)
- Kaihong Wang
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Chlöe H Armour
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Richard G J Gibbs
- Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare National Health Service Trust, Imperial College London, London, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK.
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4
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Hao Y, Závodszky G, Tersteeg C, Barzegari M, Hoekstra AG. Image-based flow simulation of platelet aggregates under different shear rates. PLoS Comput Biol 2023; 19:e1010965. [PMID: 37428797 PMCID: PMC10358939 DOI: 10.1371/journal.pcbi.1010965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023] Open
Abstract
Hemodynamics is crucial for the activation and aggregation of platelets in response to flow-induced shear. In this paper, a novel image-based computational model simulating blood flow through and around platelet aggregates is presented. The microstructure of aggregates was captured by two different modalities of microscopy images of in vitro whole blood perfusion experiments in microfluidic chambers coated with collagen. One set of images captured the geometry of the aggregate outline, while the other employed platelet labelling to infer the internal density. The platelet aggregates were modelled as a porous medium, the permeability of which was calculated with the Kozeny-Carman equation. The computational model was subsequently applied to study hemodynamics inside and around the platelet aggregates. The blood flow velocity, shear stress and kinetic force exerted on the aggregates were investigated and compared under 800 s-1, 1600 s-1 and 4000 s-1 wall shear rates. The advection-diffusion balance of agonist transport inside the platelet aggregates was also evaluated by local Péclet number. The findings show that the transport of agonists is not only affected by the shear rate but also significantly influenced by the microstructure of the aggregates. Moreover, large kinetic forces were found at the transition zone from shell to core of the aggregates, which could contribute to identifying the boundary between the shell and the core. The shear rate and the rate of elongation flow were investigated as well. The results imply that the emerging shapes of aggregates are highly correlated to the shear rate and the rate of elongation. The framework provides a way to incorporate the internal microstructure of the aggregates into the computational model and yields a better understanding of the hemodynamics and physiology of platelet aggregates, hence laying the foundation for predicting aggregation and deformation under different flow conditions.
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Affiliation(s)
- Yue Hao
- Computational Science Lab, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Gábor Závodszky
- Computational Science Lab, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Mojtaba Barzegari
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Alfons G Hoekstra
- Computational Science Lab, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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Monteleone A, Viola A, Napoli E, Burriesci G. Modelling of thrombus formation using smoothed particle hydrodynamics method. PLoS One 2023; 18:e0281424. [PMID: 36745608 PMCID: PMC9901800 DOI: 10.1371/journal.pone.0281424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
In this paper a novel model, based on the smoothed particle hydrodynamics (SPH) method, is proposed to simulate thrombus formation. This describes the main phases of the coagulative cascade through the balance of four biochemical species and three type of platelets. SPH particles can switch from fluid to solid phase when specific biochemical and physical conditions are satisfied. The interaction between blood and the forming blood clot is easily handled by an innovative monolithic FSI approach. Fluid-solid coupling is modelled by introducing elastic binds between solid particles, without requiring detention and management of the interface between the two media. The proposed model is able to realistically reproduce the thromboembolic process, as confirmed by the comparison of numerical results with experimental data available in the literature.
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Affiliation(s)
| | - Alessia Viola
- Ri.MED Foundation, Palermo, Italy
- Engineering Department, University of Palermo, Palermo, Italy
| | - Enrico Napoli
- Engineering Department, University of Palermo, Palermo, Italy
| | - Gaetano Burriesci
- Ri.MED Foundation, Palermo, Italy
- UCL Mechanical Engineering, University College London, London, United Kingdom
- * E-mail:
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Jafarinia A, Armour CH, Gibbs RGJ, Xu XY, Hochrainer T. Shear-driven modelling of thrombus formation in type B aortic dissection. Front Bioeng Biotechnol 2022; 10:1033450. [PMID: 36394040 PMCID: PMC9643857 DOI: 10.3389/fbioe.2022.1033450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Type B aortic dissection (TBAD) is a dangerous pathological condition with a high mortality rate. TBAD is initiated by an intimal tear that allows blood to flow between the aortic wall layers, causing them to separate. As a result, alongside the original aorta (true lumen), a false lumen (FL) develops. TBAD compromises the whole cardiovascular system, in the worst case resulting in complete aortic rupture. Clinical studies have shown that dilation and rupture of the FL are related to the failure of the FL to thrombose. Complete FL thrombosis has been found to improve the clinical outcomes of patients with chronic TBAD and is the desired outcome of any treatment. Partial FL thrombosis has been associated with late dissection-related deaths and the requirement for re-intervention, thus the level of FL thrombosis is dominant in classifying the risk of TBAD patients. Therefore, it is important to investigate and understand under which conditions complete thrombosis of the FL occurs. Method: Local FL hemodynamics play an essential role in thrombus formation and growth. In this study, we developed a simplified phenomenological model to predict FL thrombosis in TBAD under physiological flow conditions. Based on an existing shear-driven thrombosis model, a comprehensive model reduction study was performed to improve computational efficiency. The reduced model has been implemented in Ansys CFX and applied to a TBAD case following thoracic endovascular aortic repair (TEVAR) to test the model. Predicted thrombus formation based on post-TEVAR geometry at 1-month was compared to actual thrombus formation observed on a 3-year follow-up CT scan. Results: The predicted FL status is in excellent agreement with the 3-year follow-up scan, both in terms of thrombus location and total volume, thus validating the new model. The computational cost of the new model is significantly lower than the previous thrombus model, with an approximate 65% reduction in computational time. Such improvement means the new model is a significant step towards clinical applicability. Conclusion: The thrombosis model developed in this study is accurate and efficient at predicting FL thrombosis based on patient-specific data, and may assist clinicians in choosing individualized treatments in the future.
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Affiliation(s)
- Alireza Jafarinia
- Institute of Strength of Materials, Graz University of Technology, Graz, Austria
- *Correspondence: Alireza Jafarinia, ; Xiao Yun Xu,
| | - Chlöe H. Armour
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Richard G. J. Gibbs
- Regional Vascular Unit, St Mary’s Hospital, Imperial College Healthcare National Health Service Trust, Imperial College London, London, United Kingdom
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
- *Correspondence: Alireza Jafarinia, ; Xiao Yun Xu,
| | - Thomas Hochrainer
- Institute of Strength of Materials, Graz University of Technology, Graz, Austria
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7
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Méndez Rojano R, Lai A, Zhussupbekov M, Burgreen GW, Cook K, Antaki JF. A fibrin enhanced thrombosis model for medical devices operating at low shear regimes or large surface areas. PLoS Comput Biol 2022; 18:e1010277. [PMID: 36190991 PMCID: PMC9560616 DOI: 10.1371/journal.pcbi.1010277] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Over the past decade, much of the development of computational models of device-related thrombosis has focused on platelet activity. While those models have been successful in predicting thrombus formation in medical devices operating at high shear rates (> 5000 s−1), they cannot be directly applied to low-shear devices, such as blood oxygenators and catheters, where emerging information suggest that fibrin formation is the predominant mechanism of clotting and platelet activity plays a secondary role. In the current work, we augment an existing platelet-based model of thrombosis with a partial model of the coagulation cascade that includes contact activation of factor XII and fibrin production. To calibrate the model, we simulate a backward-facing-step flow channel that has been extensively characterized in-vitro. Next, we perform blood perfusion experiments through a microfluidic chamber mimicking a hollow fiber membrane oxygenator and validate the model against these observations. The simulation results closely match the time evolution of the thrombus height and length in the backward-facing-step experiment. Application of the model to the microfluidic hollow fiber bundle chamber capture both gross features such as the increasing clotting trend towards the outlet of the chamber, as well as finer local features such as the structure of fibrin around individual hollow fibers. Our results are in line with recent findings that suggest fibrin production, through contact activation of factor XII, drives the thrombus formation in medical devices operating at low shear rates with large surface area to volume ratios. Patients treated with blood-contacting medical devices suffer from clotting complications. Over the past decades, a great effort has been made to develop computational tools to predict and prevent clot formation in these devices. However, most models have focused on platelet activity and neglected other important parts of the problem such as the coagulation cascade reactions that lead to fibrin formation. In the current work, we incorporate this missing element into a well-established and validated model for platelet activity. We then use this novel approach to predict thrombus formation in two experimental configurations. Our results confirm that to accurately predict the clotting process in devices where surface area to volume ratios are large and flow velocity and shear stresses remain low, coagulation reactions and subsequent fibrin formation must be considered. This new model could have great implications for the design and optimization of medical devices such as blood oxygenators. In the long term, the model could evolve into a functional tool to inform anticoagulation therapies for these patients.
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Affiliation(s)
- Rodrigo Méndez Rojano
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
- * E-mail:
| | - Angela Lai
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Mansur Zhussupbekov
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
| | - Greg W. Burgreen
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, Mississippi, United States of America
| | - Keith Cook
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - James F. Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
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Qiao Y, Luo K, Fan J. Computational Prediction of Thrombosis in Food and Drug Administration's Benchmark Nozzle. Front Physiol 2022; 13:867613. [PMID: 35547578 PMCID: PMC9081348 DOI: 10.3389/fphys.2022.867613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Thrombosis seriously threatens human cardiovascular health and the safe operation of medical devices. The Food and Drug Administration’s (FDA) benchmark nozzle model was designed to include the typical structure of medical devices. However, the thrombosis in the FDA nozzle has yet not been investigated. The objective of this study is to predict the thrombus formation process in the idealized medical device by coupling computational fluid dynamics and a macroscopic hemodynamic-based thrombus model. We developed the hemodynamic-based thrombus model by considering the effect of platelet consumption. The thrombus model was quantitatively validated by referring to the latest thrombosis experiment, which was performed in a backward-facing step with human blood flow. The same setup was applied in the FDA nozzle to simulate the thrombus formation process. The thrombus shaped like a ring was firstly observed in the FDA benchmark nozzle. Subsequently, the accuracy of the shear-stress transport turbulence model was confirmed in different turbulent flow conditions. Five scenarios with different Reynolds numbers were carried out. We found that turbulence could change the shape of centrosymmetric thrombus to axisymmetric and high Reynolds number blood flow would delay or even prevent thrombosis. Overall, the present study reports the thrombosis process in the FDA benchmark nozzle using the numerical simulation method, and the primary findings may shed light on the effect of turbulence on thrombosis.
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Affiliation(s)
- Yonghui Qiao
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.,Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.,Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China
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9
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Blum C, Groß-Hardt S, Steinseifer U, Neidlin M. An Accelerated Thrombosis Model for Computational Fluid Dynamics Simulations in Rotary Blood Pumps. Cardiovasc Eng Technol 2022; 13:638-649. [PMID: 35031981 PMCID: PMC9499893 DOI: 10.1007/s13239-021-00606-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00606-y.
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Affiliation(s)
- Christopher Blum
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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10
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Manning KB, Nicoud F, Shea SM. Mathematical and Computational Modeling of Device-Induced Thrombosis. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021; 20:100349. [PMID: 35071850 PMCID: PMC8769491 DOI: 10.1016/j.cobme.2021.100349] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Given the extensive and routine use of cardiovascular devices, a major limiting factor to their success is the thrombotic rate that occurs. This both poses direct risk to the patient and requires counterbalancing with anticoagulation and other treatment strategies, contributing additional risks. Developing a better understanding of the mechanisms of device-induced thrombosis to aid in device design and medical management of patients is critical to advance the ubiquitous use and durability. Thus, mathematical and computational modelling of device-induced thrombosis has received significant attention recently, but challenges remain. Additional areas that need to be explored include microscopic/macroscopic approaches, reconciling physical and numerical timescales, immune/inflammatory responses, experimental validation, and incorporating pathologies and blood conditions. Addressing these areas will provide engineers and clinicians the tools to provide safe and effective cardiovascular devices.
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Affiliation(s)
- Keefe B. Manning
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Franck Nicoud
- CNRS, IMAG, Université de Montpellier, Montpellier, France
| | - Susan M. Shea
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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11
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Yang L, Tobin N, Manning KB. Refining a numerical model for device-induced thrombosis and investigating the effects of non-Newtonian blood models. J Biomech 2021; 120:110393. [PMID: 33784516 DOI: 10.1016/j.jbiomech.2021.110393] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
Thrombosis is one of the main causes of failure in device implantation. Computational thrombosis simulation is a convenient approach to evaluate the risk of thrombosis for a device. However, thrombosis is a complicated process involving multiple species and reactions. Application of a macroscopic, single-scale computational model for device-induced thrombosis is a cost-effective approach. The current study has refined an existing thrombosis model, which simulated thrombosis by tracing four species in blood: non-activated platelets, activated platelets, surface adherent platelets, and ADP. Platelets are activated mechanically by shear stress, and chemically by ADP. Platelet adhesion occurs on surfaces with low wall shear stress with platelet aggregation inhibited in regions of high shear stress. The study improves the existing thrombosis model by: 1) Modifying the chemical platelet activation function so that ADP activates platelets; 2) Modifying the function describing thrombus deposition and growth to distinguish between thrombus deposition on wall surfaces and thrombus growth on existing thrombus surfaces; 3) Modifying the thrombus breakdown function to allow for thrombus breakdown by shear stress; 4) Modeling blood flow as non-Newtonian. The results show that the inclusion of ADP and the use of a non-Newtonian model improve agreement with experimental data.
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Affiliation(s)
- Ling Yang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Nicolas Tobin
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA; Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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12
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Manning KB, Deutsch S, Rosenberg G. John M. Tarbell: Artificial Heart and Mechanical Heart Valve Research Contributions. Cardiovasc Eng Technol 2021; 12:9-14. [PMID: 33409858 DOI: 10.1007/s13239-020-00510-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 CBE Building, University Park, PA, 16802, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
| | - Steven Deutsch
- Department of Biomedical Engineering, The Pennsylvania State University, 122 CBE Building, University Park, PA, 16802, USA
| | - Gerson Rosenberg
- Department of Biomedical Engineering, The Pennsylvania State University, 122 CBE Building, University Park, PA, 16802, USA.,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
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13
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Yang L, Neuberger T, Manning KB. In vitro real-time magnetic resonance imaging for quantification of thrombosis. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:285-295. [PMID: 32729094 DOI: 10.1007/s10334-020-00872-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Thrombosis is a leading cause of failure for cardiovascular devices. While computational simulations are a powerful tool to predict thrombosis and evaluate the risk for medical devices, limited experimental data are available to validate the simulations. The aim of the current study is to provide experimental data of a growing thrombus for device-induced thrombosis. MATERIALS AND METHODS Thrombosis within a backward-facing step (BFS), or sudden expansion was investigated, using bovine and human blood circulated through the BFS model for 30 min, with a constant inflow rate of 0.76 L/min. Real-time three-dimensional flow-compensated magnetic resonance imaging (MRI), supported with Magnevist, a contrast agent improving thrombus delineation, was applied to quantify thrombus deposition and growth within the model. RESULTS The study showed that the BFS model induced a flow recirculation region, which facilitated thrombosis. By 30 min, in comparison to bovine blood, human blood resulted in smaller thrombus formation, in terms of the length (13.3 ± 0.6 vs. 18.1 ± 1.3 mm), height (2.3 ± 0.1 vs. 2.6 ± 0.04 mm), surface area exposed to blood (0.67 ± 0.03 vs 1.05 ± 0.08 cm2), and volume (0.069 ± 0.004 vs. 0.093 ± 0.007 cm3), with p < 0.01. Normalization of the thrombus measurements, which excluded the flow recirculation effects, suggested that the thrombus sizes increased during the first 15 min and stabilized after 20 min. Blood properties, including viscosity, hematocrit, and platelet count affected thrombosis. CONCLUSION For the first time, contrast agent-supported real-time MRI was performed to investigate thrombus deposition and growth within a sudden expansion. This study provides experimental data for device-induced thrombosis, which is valuable for validation of computational thrombosis simulations.
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Affiliation(s)
- Ling Yang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Thomas Neuberger
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA.,Huck Institutes of Life Science, The Pennsylvania State University, University Park, PA, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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14
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López JM, Fortuny G, Puigjaner D, Herrero J, Marimon F. Hemodynamic effects of blood clots trapped by an inferior vena cava filter. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3343. [PMID: 32323487 DOI: 10.1002/cnm.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
The alteration of blood flow around an OPTEASE inferior vena cava filter with one or two blood clots attached was investigated by means of computational fluid dynamics. We used a patient-specific vein wall geometry, and we generated different clot models with shapes adapted to the filter and vein wall geometries. A total of eight geometries, with one or two clots and a total clot volume of 0.5 or 1 cm3 , were considered. A non-Newtonian model for blood viscosity was adopted and the possible development of turbulence was accounted for by means of a three-equation model. Two blood flow rates were considered for each case, representative for rest and exercise conditions. In exercise conditions, flow unsteadiness and even turbulence was detected in some cases. Pressure and wall shear stress (WSS) distributions were modified in all cases. Clots attached to the filter downstream basket considerably increased averaged WSS values by up to almost 50%. In all the cases a flow recirculation region appeared downstream of the clot. The degree of flow stagnation in these regions, an indicator of propensity to thrombogenesis, was estimated in terms of mean residence times and mean blood viscosity. High levels of flow stagnation were detected in rest conditions in the wake of those clots that were placed upstream from the filter. Our results suggest that one downstream placed big clot, showing a higher tendency to induce flow instabilities and turbulence, might be more harmful than two small clots placed in tandem.
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Affiliation(s)
- Josep M López
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Gerard Fortuny
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Dolors Puigjaner
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Joan Herrero
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Francesc Marimon
- Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Catalunya, Spain
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15
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Thrombus growth modelling and stenosis prediction in the cerebral microvasculature. J Theor Biol 2019; 478:1-13. [PMID: 31207204 DOI: 10.1016/j.jtbi.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 11/22/2022]
Abstract
Cerebral microvascular occlusions cause restriction of blood supply to the brain, thus potentially severely impacting cognitive abilities. Thus, accurate prediction of thrombus growth in realistic geometries is important. Thrombi growth in an existing 13-generation cerebral microvasculature network is simulated here to study the haemodynamic effects of single and multiple blockages on the occlusion of the network. Compared to a single vessel, in a network, the occlusion probability is found to be different. It is the downstream/smaller arterioles (i.e. the 3rd, 4th, 5th, 6th generation arterioles in this study) that tend to reach occlusion first in a network and thus are the critical vessels. Simulations of simultaneous growth of two independent thrombi in the network (referred to here as the two-block case) show a close coupling between the locations of the various blocks in the network, each influencing the other's growth. The presence of the lead block (LB) slows the growth of the trailing block (TB). In some cases, it stops the TB's growth thereby preventing it from occluding the vessel. Findings in this work thus indicate that, to prevent ischaemia, blocks in the smaller arterioles need to be identified and treated first, and that this is more critical if the number of simultaneous blocks is higher.
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16
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Kadri OE, Chandran VD, Surblyte M, Voronov RS. In vivo measurement of blood clot mechanics from computational fluid dynamics based on intravital microscopy images. Comput Biol Med 2019; 106:1-11. [PMID: 30660757 PMCID: PMC6390965 DOI: 10.1016/j.compbiomed.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 12/31/2022]
Abstract
Ischemia which leads to heart attacks and strokes is one of the major causes of death in the world. Whether an occlusion occurs or not depends on the ability of a growing thrombus to resist flow forces exerted on its structure. This manuscript provides the first known in vivo measurement of how much stress a clot can withstand, before yielding to the surrounding blood flow. Namely, Lattice-Boltzmann Method flow simulations are performed based on 3D clot geometries, which are estimated from intravital microscopy images of laser-induced injuries in cremaster microvasculature of live mice. In addition to reporting the blood clot yield stresses, we also show that the thrombus "core" does not experience significant deformation, while its "shell" does. This indicates that the shell is more prone to embolization. Therefore, drugs should be designed to target the shell selectively, while leaving the core intact to minimize excessive bleeding. Finally, we laid down a foundation for a nondimensionalization procedure which unraveled a relationship between clot mechanics and biology. Hence, the proposed framework could ultimately lead to a unified theory of thrombogenesis, capable of explaining all clotting events. Thus, the findings presented herein will be beneficial to the understanding and treatment of heart attacks, strokes and hemophilia.
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Affiliation(s)
- Olufemi Emmanuel Kadri
- Otto H. York Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Vishnu Deep Chandran
- Otto H. York Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Migle Surblyte
- Ying Wu College of Computing Sciences, Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Roman S Voronov
- Otto H. York Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA.
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17
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Méndez Rojano R, Mendez S, Nicoud F. Introducing the pro-coagulant contact system in the numerical assessment of device-related thrombosis. Biomech Model Mechanobiol 2018; 17:815-826. [PMID: 29302840 DOI: 10.1007/s10237-017-0994-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/14/2017] [Indexed: 11/28/2022]
Abstract
Thrombosis is a major concern in blood-coated medical devices. Contact activation, which is the initial part of the coagulation cascade in device-related thrombosis, is not considered in current thrombus formation models. In the present study, pro-coagulant reactions including the contact activation system are coupled with a fluid solver in order to evaluate the potential of the contact system to initiate thrombin production. The biochemical/fluid model is applied to a backward-facing step configuration, a flow configuration that frequently appears in medical devices. In contrast to the in vivo thrombosis models in which a specific thrombotic zone (injury region) is set a priori by the user to initiate the coagulation reaction, a reactive surface boundary condition is applied to the whole device wall. Simulation results show large thrombin concentration in regions related to recirculation zones without the need of an a priori knowledge of the thrombus location. The numerical results align well with the regions prone to thrombosis observed in experimental results reported in the literature. This approach could complement thrombus formation models that take into account platelet activity and thrombus growth to optimize a wide range of medical devices.
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Affiliation(s)
- Rodrigo Méndez Rojano
- Institut Montpelliérain Alexander Grothendieck, CNRS, Univ. Montpellier, 2 Place Eugène Bataillon, 34095, Montpellier Cedex 5, France.
| | - Simon Mendez
- Institut Montpelliérain Alexander Grothendieck, CNRS, Univ. Montpellier, 2 Place Eugène Bataillon, 34095, Montpellier Cedex 5, France
| | - Franck Nicoud
- Institut Montpelliérain Alexander Grothendieck, CNRS, Univ. Montpellier, 2 Place Eugène Bataillon, 34095, Montpellier Cedex 5, France
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18
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Menichini C, Cheng Z, Gibbs RGJ, Xu XY. Predicting false lumen thrombosis in patient-specific models of aortic dissection. J R Soc Interface 2017; 13:rsif.2016.0759. [PMID: 27807275 PMCID: PMC5134025 DOI: 10.1098/rsif.2016.0759] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023] Open
Abstract
Aortic dissection causes splitting of the aortic wall layers, allowing blood to enter a ‘false lumen’ (FL). For type B dissection, a significant predictor of patient outcomes is patency or thrombosis of the FL. Yet, no methods are currently available to assess the chances of FL thrombosis. In this study, we present a new computational model that is capable of predicting thrombus formation, growth and its effects on blood flow under physiological conditions. Predictions of thrombus formation and growth are based on fluid shear rate, residence time and platelet distribution, which are evaluated through convection–diffusion–reaction transport equations. The model is applied to a patient-specific type B dissection for which multiple follow-up scans are available. The predicted thrombus formation and growth patterns are in good qualitative agreement with clinical data, demonstrating the potential applicability of the model in predicting FL thrombosis for individual patients. Our results show that the extent and location of thrombosis are strongly influenced by aortic dissection geometry that may change over time. The high computational efficiency of our model makes it feasible for clinical applications. By predicting which aortic dissection patient is more likely to develop FL thrombosis, the model has great potential to be used as part of a clinical decision-making tool to assess the need for early endovascular intervention for individual dissection patients.
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Affiliation(s)
- Claudia Menichini
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Zhuo Cheng
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Richard G J Gibbs
- Department of Surgery and Cancer, St Marys Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK
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19
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Matsuhashi Y, Sameshima K, Yamamoto Y, Umezu M, Iwasaki K. Investigation of the influence of fluid dynamics on thrombus growth at the interface between a connector and tube. J Artif Organs 2017; 20:293-302. [PMID: 28755017 PMCID: PMC5686247 DOI: 10.1007/s10047-017-0973-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/09/2017] [Indexed: 11/07/2022]
Abstract
Thrombus formation at the interface between connectors and tubes is a potential risk factor for complications. We investigated time-dependent relationships between formation of thrombus and hemodynamic factors at the interface between connectors and tubes using optical coherence tomography (OCT) under pulsatile flow. A swept-source OCT with the center wavelength of 1330 nm was employed. The sequential process of thrombus formation at the interface of connectors and tubes in the inlet and outlet was investigated. Connectors with and without tapers were tested using identical 50-ml air-contactless circuits. Fresh human blood from healthy volunteers was circulated under pulsatile flow. Thrombus initially formed at the interface between the connector tip and the tube. Geometries of thrombus growth were different between the 2 connectors, and between the inlet and the outlet. Growth of thrombus was observed at the interface between the connectors and tubes over time in 60 min circulation, except at the outlet part of connector without tapers. At the connector without tapers outlet, thrombus propagation length from the connector edge toward the flow downstream was comparable at 10 and 60 min (0.55 ± 0.35 vs. 0.51 ± 0.32 mm, p = 0.83). Analysis using particle image velocimetry showed the presence of a flow reattachment point 1.5 mm downstream from the connector edge. These results suggest that the flow reattachment point inhibits downstream thrombus growth. We quantitatively demonstrated sequential thrombus process at the interface between the connectors and tubes under pulsatile flow of human blood using OCT.
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Affiliation(s)
- Yuki Matsuhashi
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
| | - Kei Sameshima
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
| | - Yoshiki Yamamoto
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
| | - Mitsuo Umezu
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan.,Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
| | - Kiyotaka Iwasaki
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan. .,Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan.
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20
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Development of a platelet adhesion transport equation for a computational thrombosis model. J Biomech 2016; 50:114-120. [PMID: 27855988 DOI: 10.1016/j.jbiomech.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 01/17/2023]
Abstract
Thrombosis is a significant issue for cardiovascular device development and use. While thrombosis models are available, very few are device-related and none have been thoroughly validated experimentally. Here, we introduce a surface adherent platelet transport equation into a continuum model to account for the biomaterial interface/blood interaction. Using a rotating disc system and polyurethane-urea material, we characterize steady and pulsatile flow fields using laser Doppler velocimetry. In vitro measurements of platelet adhesion are used in combination with the LDV data to provide further experimental validation. The rotating disc system is computationally studied using the device-induced thrombosis model with the surface platelet adherent transport equation. The results indicate that the flow field is in excellent agreement to the experimental LDV data and that the platelet adhesion simulations are in good agreement with the in vitro platelet data. These results provide good evidence that this transport equation can be used to express the relationship between blood and a biomaterial if the correct platelet adhesion characteristics are known for the biomaterial. Further validation is necessary with other materials.
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21
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Taylor JO, Meyer RS, Deutsch S, Manning KB. Development of a computational model for macroscopic predictions of device-induced thrombosis. Biomech Model Mechanobiol 2016; 15:1713-1731. [PMID: 27169403 DOI: 10.1007/s10237-016-0793-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
While cardiovascular device-induced thrombosis is associated with negative patient outcomes, the convoluted nature of the processes resulting in a thrombus makes the full thrombotic network too computationally expensive to simulate in the complex geometries and flow fields associated with devices. A macroscopic, continuum computational model is developed based on a simplified network, which includes terms for platelet activation (chemical and mechanical) and thrombus deposition and growth in regions of low wall shear stress (WSS). Laminar simulations are performed in a two-dimensional asymmetric sudden expansion geometry and compared with in vitro thrombus size data collected using whole bovine blood. Additionally, the predictive power of the model is tested in a flow cell containing a series of symmetric sudden expansions and contractions. Thrombi form in the low WSS area downstream of the asymmetric expansion and grow into the nearby recirculation region, and thrombus height and length largely remain within 95 % confidence intervals calculated from the in vitro data for 30 min of blood flow. After 30 min, predicted thrombus height and length are 0.94 and 4.32 (normalized by the 2.5 mm step height). Importantly, the model also correctly predicts locations of thrombus deposition observed in the in vitro flow cell of expansions and contractions. As the simulation results, which rely on a greatly reduced model of the thrombotic network, are still able to capture the macroscopic behavior of the full network, the model shows promise for timely predictions of device-induced thrombosis toward optimizing and expediting the device development process.
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Affiliation(s)
- Joshua O Taylor
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA, 16802, USA.,Applied Research Laboratory, The Pennsylvania State University, State College, PA, USA
| | - Richard S Meyer
- Applied Research Laboratory, The Pennsylvania State University, State College, PA, USA
| | - Steven Deutsch
- Applied Research Laboratory, The Pennsylvania State University, State College, PA, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA, 16802, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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22
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A Method for Creating Artificial Thrombi In Vitro Using a Rotating Mechanical Surface. ASAIO J 2016; 62:252-60. [DOI: 10.1097/mat.0000000000000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Jamiolkowski MA, Pedersen DD, Wu WT, Antaki JF, Wagner WR. Visualization and analysis of biomaterial-centered thrombus formation within a defined crevice under flow. Biomaterials 2016; 96:72-83. [PMID: 27156141 DOI: 10.1016/j.biomaterials.2016.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/08/2016] [Accepted: 04/20/2016] [Indexed: 01/14/2023]
Abstract
The blood flow pathway within a device, together with the biomaterial surfaces and status of the patient's blood, are well-recognized factors in the development of thrombotic deposition and subsequent embolization. Blood flow patterns are of particular concern for devices such as blood pumps (i.e. ventricular assist devices, VADs) where shearing forces can be high, volumes are relatively large, and the flow fields can be complex. However, few studies have examined the effect of geometric irregularities on thrombus formation on clinically relevant opaque materials under flow. The objective of this study was to quantify human platelet deposition onto Ti6Al4V alloys, as well as positive and negative control surfaces, in the region of defined crevices (∼50-150 μm in width) that might be encountered in many VADs or other cardiovascular devices. To achieve this, reconstituted fresh human blood with hemoglobin-depleted red blood cells (to achieve optical clarity while maintaining relevant rheology), long working optics, and a custom designed parallel plate flow chamber were employed. The results showed that the least amount of platelet deposition occurred in the largest crevice size examined, which was counterintuitive. The greatest levels of deposition occurred in the 90 μm and 53 μm crevices at the lower wall shear rate. The results suggest that while crevices may be unavoidable in device manufacturing, the crevice size might be tailored, depending on the flow conditions, to reduce the risk of thromboembolic events. Further, these data might be used to improve the accuracy of predictive models of thrombotic deposition in cardiovascular devices to help optimize the blood flow path and reduce device thrombogenicity.
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Affiliation(s)
- Megan A Jamiolkowski
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Drake D Pedersen
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei-Tao Wu
- Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - James F Antaki
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Dept. of Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Dept. of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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24
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Menichini C, Xu XY. Mathematical modeling of thrombus formation in idealized models of aortic dissection: initial findings and potential applications. J Math Biol 2016; 73:1205-1226. [PMID: 27007280 PMCID: PMC5055578 DOI: 10.1007/s00285-016-0986-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 11/15/2015] [Indexed: 11/12/2022]
Abstract
Aortic dissection is a major aortic catastrophe with a high morbidity and mortality risk caused by the formation of a tear in the aortic wall. The development of a second blood filled region defined as the “false lumen” causes highly disturbed flow patterns and creates local hemodynamic conditions likely to promote the formation of thrombus in the false lumen. Previous research has shown that patient prognosis is influenced by the level of thrombosis in the false lumen, with false lumen patency and partial thrombosis being associated with late complications and complete thrombosis of the false lumen having beneficial effects on patient outcomes. In this paper, a new hemodynamics-based model is proposed to predict the formation of thrombus in Type B dissection. Shear rates, fluid residence time, and platelet distribution are employed to evaluate the likelihood for thrombosis and to simulate the growth of thrombus and its effects on blood flow over time. The model is applied to different idealized aortic dissections to investigate the effect of geometric features on thrombus formation. Our results are in qualitative agreement with in-vivo observations, and show the potential applicability of such a modeling approach to predict the progression of aortic dissection in anatomically realistic geometries.
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Affiliation(s)
- Claudia Menichini
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, SW7 2AZ, London, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, SW7 2AZ, London, UK.
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