Design of a Continuous Flow Centrifugal Pediatric Ventricular Assist Device

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.

Extending the Power-Law Hemolysis Model to Complex Flows

Hemolysis (damage to red blood cells) is a long-standing problem in blood contacting devices, and its prediction has been the goal of considerable research. The most popular model relating hemolysis to fluid stresses is the power-law model, which was developed from experiments in pure shear only. In the absence of better data, this model has been extended to more complex flows by replacing the shear stress in the power-law equation with a von Mises-like scalar stress. While the validity of the scalar stress also remains to be confirmed, inconsistencies exist in its application, in particular, two forms that vary by a factor of 2 have been used. This article will clarify the proper extension of the power law to complex flows in a way that maintains correct results in the limit of pure shear.

Comparison and experimental validation of fluid dynamic numerical models for a clinical ventricular assist device

With the recent advances in computer technology, computational fluid dynamics (CFDs) has become an important tool to design and improve blood-contacting artificial organs, and to study the device-induced blood damage. Commercial CFD software packages are readily available, and multiple CFD models are provided by CFD software developers. However, the best approach of using CFD effectively to characterize fluid flow and to predict blood damage in these medical devices remains debatable. This study aimed to compare these CFD models and provide useful information on the accuracy of each model in modeling blood flow in circulatory assist devices. The laminar and five turbulence models (Spalart-Allmaras, k-ε (k-epsilon), k-ω (k-omega), SST [Menter's Shear Stress Transport], and Reynolds Stress) were implemented to predict blood flow in a clinically used circulatory assist device, the CentriMag centrifugal blood pump. In parallel, a transparent replica of the CentriMag pump was constructed and selected views of the flow fields were measured with digital particle image velocimetry (DPIV). CFD results were compared with the DPIV experimental results. Compared with the experiment, all the selected CFD models predicted the flow pattern fairly well except the area of the outlet. However, quantitatively, the laminar model results were the most deviated from the experimental data. On the other hand, k-ε renormalization group theory models and Reynolds Stress model are the most accurate. In conclusion, for the circulatory assist devices, turbulence models provide more accurate results than the laminar model. Among the selected turbulence models, k-ε and Reynolds Stress Method models are recommended.

Surface coatings for ventricular assist devices

This article focuses on the surface engineering of ventricular assist devices (VADs) for the treatment of heart failure patients, which involves the modification of surfaces contacting blood in order to improve the blood compatibility (hemocompatibility) of the VADs. Following an introduction to the categorization and the complications of VADs, this article pays attention on the hemocompatibility, applications and limitations of six types of surface coatings for VADs: titanium nitride coatings, diamond-like carbon coatings, 2-methacryloyloxyethyl phosphorylcholine polymer coatings, heparin coatings, textured surfaces and endothelial cell linings. In particular, diamond-like coatings and heparin coatings are the most commonly used for VADs owing to their excellent hemocompatibility, durability and technical maturity. For high performance and a long lifetime of VADs, surface modification with coatings to ensure hemocompatibility is as important as the mechanical design of the device.

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

Mechanical circulatory support options for infants and children are very limited in the United States. Existing circulatory support systems have proven successful for short-term pediatric assist, but are not completely successful as a bridge-to-transplant or bridge-to-recovery. To address this substantial need for alternative pediatric mechanical assist, we are developing a novel, magnetically levitated, axial flow pediatric ventricular assist device (PVAD) intended for longer-term ventricular support. Three major numerical design and optimization phases have been completed. A prototype was built based on the latest numerical design (PVAD3) and hydraulically tested in a flow loop. The plastic PVAD prototype delivered 0.5-4 lpm, generating pressure rises of 50-115 mm Hg for operating speeds of 6,000-9,000 rpm. The experimental testing data and the numerical predictions correlated well. The error between these sets of data was found to be generally 7.8% with a maximum deviation of 24% at higher flow rates. The axial fluid forces for the numerical simulations ranged from 0.5 to 1 N and deviated from the experimental results by generally 8.5% with a maximum deviation of 12% at higher flow rates. These hydraulic results demonstrate the excellent performance of the PVAD3 and illustrate the achievement of the design objectives.

Fluid force predictions and experimental measurements for a magnetically levitated pediatric ventricular assist device

The latest generation of artificial blood pumps incorporates the use of magnetic bearings to levitate the rotating component of the pump, the impeller. A magnetic suspension prevents the rotating impeller from contacting the internal surfaces of the pump and reduces regions of stagnant and high shear flow that surround fluid or mechanical bearings. Applying this third-generation technology, the Virginia Artificial Heart Institute has developed a ventricular assist device (VAD) to support infants and children. In consideration of the suspension design, the axial and radial fluid forces exerted on the rotor of the pediatric VAD were estimated using computational fluid dynamics (CFD) such that fluid perturbations would be counterbalanced. In addition, a prototype was built for experimental measurements of the axial fluid forces and estimations of the radial fluid forces during operation using a blood analog mixture. The axial fluid forces for a centered impeller position were found to range from 0.5 +/- 0.01 to 1 +/- 0.02 N in magnitude for 0.5 +/- 0.095 to 3.5 +/- 0.164 Lpm over rotational speeds of 6110 +/- 0.39 to 8030 +/- 0.57% rpm. The CFD predictions for the axial forces deviated from the experimental data by approximately 8.5% with a maximum difference of 18% at higher flow rates. Similarly for the off-centered impeller conditions, the maximum radial fluid force along the y-axis was found to be -0.57 +/- 0.17 N. The maximum cross-coupling force in the x direction was found to be larger with a maximum value of 0.74 +/- 0.22 N. This resulted in a 25-35% overestimate of the radial fluid force as compared to the CFD predictions; this overestimation will lead to a far more robust magnetic suspension design. The axial and radial forces estimated from the computational results are well within a range over which a compact magnetic suspension can compensate for flow perturbations. This study also serves as an effective and novel design methodology for blood pump developers employing magnetic suspensions. Following a final design evaluation, a magnetically suspended pediatric VAD will be constructed for extensive hydraulic and animal testing as well as additional validation of this design methodology.

Initial Experience With the Development and Numerical and In Vitro Studies of A Novel Low-Pressure Artificial Right Ventricle for Pediatric Fontan Patients

The Fontan operation, an efficient palliative surgery, is performed for patients with single-ventricle pathologies. The total cavopulmonary connection is a preferred Fontan procedure in which the superior and inferior vena cava are connected to the left and right pulmonary artery. The overall goal of this work is to develop an artificial right ventricle that can be introduced into the inferior vena cava, which would act to reverse the deleterious hemodynamics in post-Fontan patients. We present the initial design and computational analysis of a micro-axial pump, designed with the particular hemodynamics of Fontan physiology in mind. Preliminary in vitro data on a prototype pump are also presented. Computational studies showed that the new design can deliver a variety of advantageous operating conditions, including decreased venous pressure through proximal suction, increased pressure rise across the pump, increased pulmonary flows, and minimal changes in superior vena cava pressures. In vitro studies on a scaled prototype showed trends similar to those seen computationally. We conclude that a micro-axial flow pump can be designed to operate efficiently within the low-pressure, low-flow environment of cavopulmonary flows. The results provide encouragement to pursue this design to for in vitro studies and animal studies.

Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices

Background— Current ventricular assist devices (VADs) in the United States are designed primarily for adult use. Data on VADs as a bridge to transplantation in children are limited.

Methods and Results— A multi-institutional, prospectively maintained database of outcomes in children after listing for heart transplantation (n=2375) was used to analyze outcomes of VAD patients (n=99, 4%) listed between January 1993 and December 2003. Median age at VAD implantation was 13.3 years (range, 2 days to 17.9 years); diagnoses were cardiomyopathy (78%) and congenital heart disease (22%). Mean duration of support was 57 days (range, 1 to 465 days). Seventy-three percent were supported with a long-term device, with 39% requiring biventricular support. Seventy-seven patients (77%) survived to transplantation, 5 patients were successfully weaned from support and recovered, and 17 patients (17%) died on support. In the recent era (2000 to 2003), successful bridge to transplantation with VAD was achieved in 86% of patients. Peak hazard for death while waiting was the first 2 weeks after VAD placement. Risk factors for death while awaiting a transplant included earlier era of implantation ( P =0.05), female gender ( P =0.02), and congenital disease diagnosis ( P =0.05). There was no difference in 5-year survival after transplantation for patients on VAD at time of transplantation as compared with those not requiring VAD.

Conclusions— VAD support in children successfully bridged 77% of patients to transplantation, with posttransplantation outcomes comparable to those not requiring VAD. These encouraging results emphasize the need to further understand patient selection and to delineate the impact of VAD technology for children.

Computational Design and Experimental Performance Testing of an Axial-Flow Pediatric Ventricular Assist Device

The Virginia Artificial Heart Institute continues to design and develop an axial-flow pediatric ventricular assist device (PVAD) for infants and children in the United States. Our research team has created a database to track potential PVAD candidates at the University of Virginia Children's Hospital. The findings of this database aided with need assessment and design optimization of the PVAD. A numerical analysis of the optimized PVAD1 design (PVAD2 model) was also completed using computational fluid dynamics (CFD) to predict pressure-flow performance, fluid force estimations, and blood damage levels in the flow domain. Based on the PVAD2 model and after alterations to accommodate manufacturing, a plastic prototype for experimental flow testing was constructed via rapid prototyping techniques or stereolithography. CFD predictions demonstrated a pressure rise range of 36-118 mm Hg and axial fluid forces of 0.8-1.7 N for flows of 0.5-3 l/min over 7000-9000 rpm. Blood damage indices per CFD ranged from 0.24% to 0.35% for 200 massless and inert particles analyzed. Approximately 187 (93.5%) of the particles took less than 0.14 seconds to travel completely through the PVAD. The mean residence time was 0.105 seconds with a maximum time of 0.224 seconds. Additionally, in a water/glycerin blood analog solution, the plastic prototype produced pressure rises of 20-160 mm Hg for rotational speeds of 5960 +/- 18 rpm to 9975 +/- 31 rpm over flows from 0.5 to 4.5 l/min. The numerical results for the PVAD2 and the prototype hydraulic testing indicate an acceptable design for the pump, represent a significant step in the development phase of this device, and encourage manufacturing of a magnetically levitated prototype for animal experiments.

Transient and quasi-steady computational fluid dynamics study of a left ventricular assist device

The HeartQuest continuous flow left ventricle assist device (LVAD) with a magnetically levitated impeller operates under highly transient flow conditions. Due to insertion of the in-flow cannula into the apex of the left ventricle, the inlet flow rate is transient because of ventricular contraction, and the pump's asymmetric circumferential configuration with five rotating blades forces blood intermittently through the pump to the great arteries. These two transient conditions correspond to time varying boundary conditions and transient rotational sliding interfaces in computational fluid dynamics (CFD). CFD was used to investigate the pump's performance under these dynamic flow conditions. A quasi-steady analysis was also conducted to evaluate the difference between the steady and transient analyses and demonstrate the significance of transient analysis, especially for transient rotational sliding interfaces transient simulations. This transient flow analysis can be applied generally in the design process of LVADs; it provides more reliable fluid forces and moments on the impeller for successful design of the magnetic suspension system and motor.