A fibrin enhanced thrombosis model for medical devices operating at low shear regimes or large surface areas

Improving hydraulic performance of the left atrial assist device using computational fluid dynamics

BACKGROUND

The left atrial assist device (LAAD) is a novel continuous-flow pump designed to treat patients with heart failure with preserved ejection fraction, a growing type of heart failure, but with limited device-treatment options. The LAAD is implanted in the mitral plane and pumps blood from the left atrium into the left ventricle. The purpose of this study was to refine the initial design of the LAAD, using results from computational fluid dynamics (CFD) analyses to inform changes that could improve hydraulic performance and flow patterns within the LAAD.

METHODS

The initial design and three variations were simulated, exploring changes to the primary impeller blades, the housing shape, and the number, size, and curvature of the diffuser vanes. Several pump rotational speeds and flow rates spanning the intended range of use were modeled.

RESULTS

Guided by the insight gained from each design iteration, the final design incorporated impeller blades with improved alignment relative to the incoming flow and wider, more curved diffuser vanes that better aligned with the approaching flow from the volute. These design adjustments reduced flow separation within the impeller and diffuser regions. In vitro testing confirmed the CFD predicted improvement in the hydraulic performance of the revised LAAD flow path design.

CONCLUSIONS

The CFD results from this study provided insight into the key pump design-related parameters that can be adjusted to improve the LAAD's hydraulic performance and internal flow patterns. This work also provided a foundation for future studies assessing the LAAD's biocompatibility under clinical conditions.

Effect of artificial lung fiber bundle geometric design on micro- and macro-scale clot formation

The hollow fiber membrane bundle is the functional component of artificial lungs, transferring oxygen to and carbon dioxide from the blood. It is also the primary location of blood clot formation and propagation in these devices. The geometric design of fiber bundles is defined by a narrow set of parameters that determine gas exchange efficiency and blood flow resistance, principally: fiber packing density, path length, and frontal area. These same parameters also affect thrombosis. This study investigated the effect of these parameters on clot formation using 3D printed flow chambers that mimic the geometry and blood flow patterns of fiber bundles. Hollow fibers were represented by an array of vertical micro-rods (380 μm diameter) arranged with three packing densities (40%, 50%, and 60%) and two path lengths (2 and 4 cm). Blood was pumped through these devices corresponding to three mean blood flow velocities (16, 20, and 25 cm/min). Results showed that (1) clot formation decreases dramatically with decreasing packing density and increasing blood flow velocity, (2) clot formation at the outlet of the fiber bundle enhances deposition upstream, and consequently (3) greater path length provides greater clot-free fiber surface area for gas exchange than a shorter path length. These results can help guide the design of less thrombogenic, more efficient artificial lung designs.

Computer based visualization of clot structures in extracorporeal membrane oxygenation and histological clot investigations for understanding thrombosis in membrane lungs

Extracorporeal membrane oxygenation (ECMO) was established as a treatment for severe cardiac or respiratory disease. Intra-device clot formation is a common risk. This is based on complex coagulation phenomena which are not yet sufficiently understood. The objective was the development and validation of a methodology to capture the key properties of clots deposed in membrane lungs (MLs), such as clot size, distribution, burden, and composition. One end-of-therapy PLS ML was examined. Clot detection was performed using multidetector computed tomography (MDCT), microcomputed tomography (μCT), and photography of fiber mats (fiber mat imaging, FMI). Histological staining was conducted for von Willebrand factor (vWF), platelets (CD42b, CD62P), fibrin, and nucleated cells (4', 6-diamidino-2-phenylindole, DAPI). The three imaging methods showed similar clot distribution inside the ML. Independent of the imaging method, clot loading was detected predominantly in the inlet chamber of the ML. The μCT had the highest accuracy. However, it was more expensive and time consuming than MDCT or FMI. The MDCT detected the clots with low scanning time. Due to its lower resolution, it only showed clotted areas but not the exact shape of clot structures. FMI represented the simplest variant, requiring little effort and resources. FMI allowed clot localization and calculation of clot volume. Histological evaluation indicated omnipresent immunological deposits throughout the ML. Visually clot-free areas were covered with leukocytes and platelets forming platelet-leukocyte aggregates (PLAs). Cells were embedded in vWF cobwebs, while vWF fibers were negligible. In conclusion, the presented methodology allowed adequate clot identification and histological classification of possible thrombosis markers such as PLAs.

Numerical Study on the Impact of Central Venous Catheter Placement on Blood Flow in the Cavo-Atrial Junction

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.

Open-Source Image-Based Tool to Experimentally Evaluate Blood Residence Time in Clinical Devices

This article introduces an open-source tool to experimentally compare blood residence time in biomedical devices using an image-based method. The experimental setup and the postprocessing workflow are comprehensively elucidated in a detailed report that conducts a thorough comparison of the residence times of a blood analog within three distinct blood oxygenator prototypes. To enable widespread accessibility and ease of use, the user-friendly MATLAB App developed for the analysis is available on the Mathworks repository: https://www.mathworks.com/matlabcentral/fileexchange/135156 .

Flow characterization of Maquet and Bio-Medicus multi-stage drainage cannulae during venoarterial extracorporeal membrane oxygenation

BACKGROUND

Drainage cannulae extract blood from a patient during venoarterial extracorporeal membrane oxygenation (VA ECMO), a treatment that temporarily supports patients undergoing severe heart and/or lung dysfunction. Currently, the two most commonly used multi-stage drainage cannulae are manufactured by Maquet and Bio-Medicus, but their designs vary in many aspects which impacts the generated flow dynamics. Therefore, this study aimed to use computational fluid dynamics (CFD) to explore the flow characteristics of the aforementioned cannulae and their impact on complications such as thrombosis.

METHODS

The Maquet and Bio-Medicus cannulae were 3D modelled within a patient-specific geometry of the venous vasculature taken from a computed tomography scan of a patient undergoing VA ECMO. A drainage flow rate of 4 L/min was assigned to each cannula. Lastly, a stress blended eddy simulation turbulence model was employed to resolve bulk flow turbulence.

RESULTS

The proximal row of side holes in both cannulae generated high intensity counter-rotating vortices, thus generating supraphysiological shear. These proximal rows were also responsible for the majority of flow extraction in both cannulae (>1.6 L/min). Despite identical simulation settings, each cannulae had differing impacts on global flow dynamics. For instance, the Bio-Medicus model produced a total stagnant blood volume of 25.6 ml, compared to 17.8 ml the Maquet cannula, thereby increasing the risk of thrombosis.

CONCLUSIONS

Overall, our results demonstrate that differences in design clearly impact flow dynamics and risk of complications. Therefore, further work in optimizing cannula design may be beneficial to prevent harmful flow characteristics.

Integrating biomarkers for hemostatic disorders into computational models of blood clot formation: A systematic review

<p>In the pursuit of personalized medicine, there is a growing demand for computational models with parameters that are easily obtainable to accelerate the development of potential solutions. Blood tests, owing to their affordability, accessibility, and routine use in healthcare, offer valuable biomarkers for assessing hemostatic balance in thrombotic and bleeding disorders. Incorporating these biomarkers into computational models of blood coagulation is crucial for creating patient-specific models, which allow for the analysis of the influence of these biomarkers on clot formation. This systematic review aims to examine how clinically relevant biomarkers are integrated into computational models of blood clot formation, thereby advancing discussions on integration methodologies, identifying current gaps, and recommending future research directions. A systematic review was conducted following the PRISMA protocol, focusing on ten clinically significant biomarkers associated with hemostatic disorders: D-dimer, fibrinogen, Von Willebrand factor, factor Ⅷ, P-selectin, prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin Ⅲ, protein C, and protein S. By utilizing this set of biomarkers, this review underscores their integration into computational models and emphasizes their integration in the context of venous thromboembolism and hemophilia. Eligibility criteria included mathematical models of thrombin generation, blood clotting, or fibrin formation under flow, incorporating at least one of these biomarkers. A total of 53 articles were included in this review. Results indicate that commonly used biomarkers such as D-dimer, PT, and APTT are rarely and superficially integrated into computational blood coagulation models. Additionally, the kinetic parameters governing the dynamics of blood clot formation demonstrated significant variability across studies, with discrepancies of up to 1, 000-fold. This review highlights a critical gap in the availability of computational models based on phenomenological or first-principles approaches that effectively incorporate affordable and routinely used clinical test results for predicting blood coagulation. This hinders the development of practical tools for clinical application, as current mathematical models often fail to consider precise, patient-specific values. This limitation is especially pronounced in patients with conditions such as hemophilia, protein C and S deficiencies, or antithrombin deficiency. Addressing these challenges by developing patient-specific models that account for kinetic variability is crucial for advancing personalized medicine in the field of hemostasis.</p>

Exploratory Simulation of Thrombosis in a Temporary LVAD Catheter Pump within a Virtual In-vivo Left Heart Environment

Percutaneous catheter pumps are intraventricular temporary mechanical circulatory support (MCS) devices that are positioned across the aortic valve into the left ventricle (LV) and provide continuous antegrade blood flow from the LV into the ascending aorta (AA). MCS devices are most often computationally evaluated as isolated devices subject to idealized steady-state blood flow conditions. In clinical practice, MCS devices operate connected to or within diseased pulsatile native hearts and are often complicated by hemocompatibility related adverse events such as stroke, bleeding, and thrombosis. Whereas aspects of the human circulation are increasingly being simulated via computational methods, the precise interplay of pulsatile LV hemodynamics with MCS pump hemocompatibility remains mostly unknown and not well characterized. Technologies are rapidly converging such that next-generation MCS devices will soon be evaluated in virtual physiological environments that increasingly mimic clinical settings. The purpose of this brief communication is to report results and lessons learned from an exploratory CFD simulation of hemodynamics and thrombosis for a catheter pump situated within a virtual in-vivo left heart environment.

clotFoam: An Open-Source Framework to Simulate Blood Clot Formation Under Arterial Flow

Blood clotting involves the coupled processes of platelet aggregation and coagulation. Simulating clotting under flow in complex geometries is challenging due to multiple temporal and spatial scales and high computational cost. clotFoam is an open-source software developed in OpenFOAM that employs a continuum model of platelet advection, diffusion, and aggregation in a dynamic fluid environment and a simplified coagulation model with proteins that advect, diffuse, and react within the fluid and with wall-bound species through reactive boundary conditions. Our framework provides the foundation on which one can build more complex models and perform reliable simulations in almost any computational domain.

Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

Introduction: Chronic heart disease (CHD) is a common comorbidity of patients receiving endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA). The explicit relationship between ventricular systolic function and EVAR complication of thrombotic events is unknown. Methods: In this study, we proposed a three-dimensional numerical model coupled with the lumped-elements heart model, which is capable of simulating thrombus formation in diverse systolic functions. The relation of cardiac functions and the predicted risk of thrombus formation in the aorta and/or endograft of 4 patients who underwent EVAR was investigated. Relative risks for thrombus formation were identified using machine-learning algorithms. Results: The computational results demonstrate that thrombus tended to form on the interior side of the aorta arch and iliac branches, and cardiac function can affect blood flow field and affect thrombus formation, which is consistent with the four patients' post-operative imaging follow-up. We also found that RRT, OSI, TAWSS in thrombosis area are lower than whole average. In addition, we found that the thrombus formation has negative correlations with the maximum ventricular contractile force (r = -.281 ± .101) and positive correlations with the minimum ventricular contractile force (r = .238 ± .074), whereas the effect of heart rate (r = -.015 ± .121) on thrombus formation is not significant. Conclusion: In conclusion, changes in ventricular systolic function may alter the risk of thrombotic events after EVAR repair, which could provide insight into the selection of adjuvant therapy strategies for AAA patients with CHD.