Real-time Lung Weight Measurement During Cellular Ex Vivo Lung Perfusion: An Early Predictor of Transplant Suitability

BACKGROUND

Increased extravascular lung water during ex vivo lung perfusion (EVLP) is associated with ischemia reperfusion injury and poor pulmonary function. A non-invasive technique for evaluating extravascular lung water during EVLP is desired to assess the transplant suitability of lungs. We investigated real-time lung weight measurements as a reliable method for assessing pulmonary functions in cellular EVLP using a porcine lung model.

METHODS

Fifteen pigs were randomly divided into 3 groups: control (no warm ischemia) or donation after circulatory death groups with 60 or 90 min of warm ischemia (n = 5, each). Real-time lung weight gain was measured by load cells positioned at the bottom of the organ chamber.

RESULTS

Real-time lung weight gain at 2 h was significantly correlated with lung weight gain as measured on a back table ( R  = 0.979, P  < 0.01). Lung weight gain in non-suitable cases (n = 6) was significantly higher than in suitable cases (n = 9) at 40 min (51.6 ± 46.0 versus -8.8 ± 25.7 g; P  < 0.01, cutoff = +12 g, area under the curve = 0.907). Lung weight gain at 40 min was significantly correlated with PaO 2 /FiO 2 , peak inspiratory pressure, shunt ratio, wet/dry ratio, and transplant suitability at 2 h ( P  < 0.05, each). In non-suitable cases, lung weight gain at 66% and 100% of cardiac output was significantly higher than at 33% ( P  < 0.05).

CONCLUSIONS

Real-time lung weight measurement could potentially be an early predictor of pulmonary function in cellular EVLP.

Left ventricular assist device mode: Co-pulse left ventricular unloading in a working mode of ex vivo heart perfusion

BACKGROUND

For normothermic ex vivo heart perfusion (EVHP), a resting mode and working mode have been proposed. We newly developed a left ventricular assist device (LVAD) mode that supports heart contraction by co-pulse synchronized LVAD.

METHODS

Following resting mode during time 0 to 1 hour, pig hearts (n = 18) were perfused in either resting, working, or LVAD mode during time 1 to 5 hour, and then myocardial function was evaluated in working mode at 6 hour. The preservation ratio was defined as the myocardial mechanical function at 330 minute divided by the function at 75 minute. In LVAD mode, LVAD unloaded the pressure and the volume in the left ventricle in the systolic phase.

RESULTS

The LVAD group was significantly associated with higher preservation ratios in cardiac output (resting, 33 ± 3; working, 35 ± 5; LVAD, 76% ± 5%; p < 0.001), stroke work, dP/dt maximum, and dP/dt minimum compared with the other groups. Glucose consumption was significantly reduced in the resting group. The LVAD group was significantly associated with higher myocardial oxygen consumption (resting, 2.2 ± 0.3; working; 4.6 ± 0.5; LVAD, 6.1 ± 0.5 mL O₂/min/100 g, p < 0.001) and higher adenosine triphosphate (ATP) levels (resting, 1.1 ± 0.1; working, 0.7 ± 0.1; LVAD, 1.6 ± 0.2 μmol/g, p = 0.001) compared with the others.

CONCLUSION

These data suggest that myocardial mechanical function was better preserved in LVAD mode than in resting and working modes. Although our data suggested similar glycolysis activity in the LVAD and working groups, the higher final ATP in the LVAD group might be explained by reduced external work in LVAD.

Lung thermography during the initial reperfusion period to assess pulmonary function in cellular ex vivo lung perfusion

BACKGROUND

Thermography is a non-invasive technology to detect low temperatures in poorly circulated areas. In ex vivo lung perfusion (EVLP), lungs are rewarmed to body temperature during the initial 1 h. Currently, the effect of graft thermal changes during the rewarming phase on pulmonary function is unknown. In this study, we evaluated the correlation of lung surface temperature with physiological parameters, wet/dry ratio, and transplant suitability in Lund-type EVLP.

METHODS

Fifteen pigs were divided into three groups: control group (no warm ischemia) or donation after circulatory death groups with 60 or 90 min of warm ischemia (n = 5, each). Thermal images of the lower lobes were continuously collected from the bottom of organ chamber using infrared thermography throughout EVLP.

RESULTS

At 8 min, lung surface temperatures of non-suitable cases were significantly lower than in suitable cases (25.1 ± 0.6 vs. 27.8 ± 1.2°C, P < 0.001), while there was no difference in lung surface temperature between the two groups at 0-4 min and 12-120 min. There was a significant negative correlation between lung surface temperature at 8 min and wet/dry ratio at 2 h in the lower lobes (R = -0.769, P < 0.001, cut-off = 26°C, Area under the curve = 1.0). A lung surface temperature of < 26°C was significantly correlated with poor pulmonary function and transplant non-suitability.

CONCLUSION

A lung surface temperature of ≥ 26°C at 8 min is a good early predictor of transplant suitability in cellular EVLP and might be applicable in clinical EVLP.

Impact of gap size and groove design of hydrodynamic bearing on plasma skimming effect for use in rotary blood pump

Plasma skimming can exclude red blood cells from high shear regions in the gaps formed by hydrodynamic bearings in rotary blood pumps. We investigated the effect of the gap size and groove design on the plasma skimming efficiency. Spiral groove bearings (SGBs) were installed into a specially designed test rig for in vitro experiments performed using human blood. The measured gap between the ridges of the bearing and the rotor surface was 17-26 µm at a flow rate of 150 ml/min and a rotor speed of 2400 rpm. Three different patterns of SGBs were designed (SGB-0, SGB-30, and SGB-60) with various degrees of the circumferential component. The hematocrit measured by a high-speed camera was compared with the hematocrit in the circuit, and the plasma skimming efficiency for the three bearing patterns was evaluated at hematocrits of 20%, 25%, and 30%. SGB-60, which had the strongest circumferential component, provided the best plasma skimming efficiency. When the gap size was less than 20 µm, the red blood cells in the gaps between the ridges of the bearing and rotor surface reduced significantly and the efficiency became higher than 90%. The gap size had the strongest effect on producing a significant plasma skimming. The plasma skimming efficiency can be significantly improved by optimizing the bearing gap size and groove design, which facilitates the further development of SGBs for use in applications such as rotary blood pumps.

Optical oxygen saturation imaging in cellular ex vivo lung perfusion to assess lobular pulmonary function

Ex vivo lung perfusion (EVLP) is an emerging tool to evaluate marginal lungs in lung transplantation. However, there is no objective metric to monitor lobular regional oxygenation during EVLP. In this study, we developed oxygen saturation (SaO₂) imaging to quantitatively assess the regional gas exchange potential of the lower lobes. Ten porcine lungs were randomly divided into control and donation after circulatory death (DCD) groups (n = 5, each). Lungs were perfused in cellular EVLP for 2 h, and multispectral images were continuously collected from the dorsal sides of the lower lobes. We examined whether lower lobe SaO₂ correlated with PaO₂/FiO₂ (P/F) ratios in lower pulmonary veins (PV). The wet/dry ratio in lower lobes was measured and Monte Carlo simulations were performed to investigate the method's feasibility. There was a significant correlation between lower lobe SaO₂ and the P/F ratio in lower PV (r = 0.855, P < 0.001). The DCD group was associated with lower SaO₂ and higher wet/dry ratio than the control group (P < 0.001). The error of estimated SaO₂ was limited according to Monte Carlo simulations. The developed technology provides a noninvasive and regional evaluative tool of quantitative lobular function in EVLP.

Analysis of Plasma Skimming within a Hydrodynamic Bearing Gap for Designing Spiral Groove Bearings in Rotary Blood Pumps

The blood damage problem inside the narrow hydrodynamic bearing is potentially considered to be solved by applying plasma skimming. However, the consideration of improving plasma skimming has not been included in the design of hydrodynamic bearings. The absence of experimental investigation on revealing the relationship between blood flow and plasma skimming in the bearing gap impedes the design of groove shape for plasma skimming. Thus, the present study was undertaken to evaluate how the blood flow direction and the groove shape affect plasma skimming in the bearing gap. To this end, blood tests using porcine blood were repeated three times with a hematocrit of 0.8%. The bearing gap during the tests was adjusted to 25 µm and the rotational speed was adjusted from 50 rpm to 2500 rpm. The blood flow and plasma skimming effect was evaluated based on image analysis utilizing a high-speed microscope. Results of three tests indicated that the flow direction of RBCs was dominated by the rotating surface in the bearing gap when the rotational speed increased over 1200 rpm. The best plasma skimming effect was observed when the angle between the flow direction of RBCs and the tangent line of the groove was within -10 degrees to 10 degrees. The future study will be conducted with including the consideration of plasma skimming in the bearing shape design. The findings in this study aid the future design and development of hydrodynamic bearing for use in rotary blood pumps.

In vitro hemocompatibility investigation for the development of low-flow centrifugal blood pumps with less platelet clogging

Low-flow blood pumps rated under 1 L/min are emerging for new medical applications, such as hemofiltration in acute use. In those pumps, platelet adhesion and aggregation have to be carefully considered because of clogging risk in the filter part. To find an acceptable hemocompatibility that can be applied to low-flow centrifugal blood pump design, the platelet aggregation index, clogging on a micromesh filter, and the hemolysis index were investigated using a low-flow blood pump designed for hemofiltration use. We conducted circulation testing in vitro using fresh porcine blood and two centrifugal pumps with different impeller inlet shapes. The Negative Log Platelet Aggregation Threshold Index (NL-PATI), which reflects the ability of residual platelets to aggregate, and flow rate were measured during reflux for 60 min, and the Normalized Index of Hemolysis (NIH (g/20 min)) was calculated. In addition, blood cell clogging after reflux was observed on the micromesh filter by SEM, and the adhesion rate was calculated. Our results showed that the platelet clogging on the micromesh filter occurred when the average NL-PATI was greater than 0.28 and the average NIH (g/20 min) was greater than 0.01. In contrast, platelet clogging on the micromesh was suppressed when NL-PATI was less than 0.17 and the NIH (g/20 min) was less than 0.003. These values might be used as acceptable hemocompatibility of low-flow centrifugal blood pumps with suppressed platelet clogging for hemofiltration pumps.

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

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

Improvement of hemolysis performance in a hydrodynamically levitated centrifugal blood pump by optimizing a shroud size

We have developed a hydrodynamically levitated centrifugal blood pump. In the blood pump having hydrodynamic bearings, the narrow bearing gap has a potential for high hemolysis. The purpose of the this study is to improve hemolysis performance in a hydrodynamically levitated centrifugal blood pump by optimizing a shroud size. The impeller was levitated passively at the position where the thrust forces acting on the impeller were balanced. We focused on a size of a bottom shroud with a hydrodynamic bearing that could change the bottom hydrodynamic force to balance the thrust force at the wide bearing gap for reducing hemolysis. Five test models with various shroud size were compared: 989 mm² (HH-10.5), 962 mm² (HH-12), 932 mm² (HH-13.5), 874 mm² (HH-16), and 821 mm² (HH-18). A numerical analysis was first performed to estimate the bearing gaps in the test model. The bearing gaps were then measured to validate the numerical analysis. Finally, an in vitro hemolysis test was performed. The numerical analysis revealed that the HH-13.5 model had the widest bearing gap of 129 µm. In the measurement test, the estimation error for the bearing gap was less than 10%. In the hemolysis test, the HH-13.5 model achieved the lowest hemolysis level among the five models. The present study demonstrated that the numerical analysis was found to be effective for determining the optimal should size, and the HH-13.5 model had the optimal shroud size in the developed hydrodynamically levitated centrifugal blood pump to reduce hemolysis.

Real-time, non-invasive thrombus detection in an extracorporeal circuit using micro-optical thrombus sensors

Introduction:

Real-time, non-invasive monitoring of thrombus formation in extracorporeal circuits has yet to be achieved. To address the challenges of conventional optical thrombus detection methods requiring large devices that limit detection capacity, we developed a micro-optical thrombus sensor.

Methods:

The proposed micro-optical thrombus sensor can detect the intensity of light scattered by blood at wavelengths of 660 and 855 nm. Two thrombus sensors were installed on in vitro circuit: one at the rotary blood pump and one at a flow channel. To evaluate the variation in the ratio of incident light intensity at each wavelength of the two sensors, R_fluct (for 660 nm) and I_fluct (for 855 nm) were defined. Using fresh porcine blood as a working fluid, we performed in vitro tests of haematocrit (Hct) and oxygen saturation (SaO₂) variation and thrombus detection. Thrombus tests were terminated after R_fluct or I_fluct showed a larger change than the maximum range of those in the Hct and SaO₂ variation test.

Results:

In all three thrombus detection tests, I_fluct showed a larger change than the maximum range of those in the Hct and SaO₂ variation test. After the tests, thrombus formation was confirmed in the pump, and there was no thrombus in the flow channel. The results indicate that I_fluct is an effective parameter for identifying the presence of a thrombus.

Conclusion:

Thrombus detection in an extracorporeal circuit using the developed micro-optical sensors was successfully demonstrated in an in vitro test.

Evaluating Plasma Skimming with Whole Blood in Small Gap Region Imitating Clearance of Blood Pumps

Plasma skimming is the phenomenon whereby the discharge hematocrit is lower than feed hematocrit naturally occurring in the microvessels with Poiseuille flow. It has been studied in Poiseuille flow extensively. Besides, plasma skimming has also been observed and investigated in blood pumps due to its potential to prevent hemolysis by skimming blood cells out of the small gap. However, whether plasma skimming occurs in blood pumps with whole blood has not been verified. Additionally, the independent influence of rotational speed and gap size has not been clarified. Therefore, in order to lay the foundation of applying plasma skimming to the development of blood pumps and also investigate the influence of rotational speed and gap size on plasma skimming respectively, we designed a simplified geometric device which not only imitates the flow inside clearances of blood pumps, but also provides different rotational speed and gap size conditions. We first conducted the verification tests of plasma skimming using whole blood with an initial hematocrit of 44% and the gap size was varied from 10 μm to 240 μm with 10 μm interval. The plasma skimming was verified occurring when the gap was less than 70 μm at a rotational speed of 800 rpm. Since plasma skimming was confirmed, we employed 30% hematocrit blood and performed the following tests to evaluate the influence of rotational speed of 600 rpm, 700 rpm, and 800 rpm respectively. As a result, the hematocrit of sampled blood declined as the rotational speed increased from 600 rpm to 800 rpm. And there was the lowest hematocrit of 16% when the gap was adjusted to 50 μm gap size at 800 rpm. This study further promotes the possibility of applying plasma skimming to the blood pumps with higher hemocapability.

Development of an Intelligent Ventricular Assist Device with a Function of Sensorless Thrombus Detection

Thrombus is one of the major problems in ventricular assist devices (VADs). However, method for detecting thrombus in early stage has not been established yet. In this study, we propose an intelligent function that the VAD itself can detect thrombus automatically and alert it to medical staffs. In the proposed method, thrombus formation inside a blood pump is detected by monitoring blood viscosity. This viscosity measurement is performed by using magnetic levitation system for the impeller. Hence, it can be implemented without any additional sensors or mechanisms in principle. For verification of the method, at first, we visualized inside of the pump during thrombus formation with measuring blood viscosity by using erythrocytes removed porcine blood. The result showed that the viscosity of the blood increased as blood coagulation progressed. Then, we conducted in vitro principle verification experiments with three different whole porcine blood. In all experiments, the measured blood viscosity increased and small thrombus was observed inside the pump. From these results, we confirmed that the proposed method has a possibility to detect and predict the thrombus in early stage.

Development of a real-time and quantitative thrombus sensor for an extracorporeal centrifugal blood pump by near-infrared light

We developed an optical thrombus sensor for a monopivot extracorporeal centrifugal blood pump. In this study, we investigated its quantitative performance for thrombus detection in acute animal experiments of left ventricular assist using the pump on pathogen-free pigs. Optical fibers were set in the driver unit of the pump. The incident light at the near-infrared wavelength of 810 nm was aimed at the pivot bearing, and the resulting scattered light was guided to the optical fibers. The detected signal was analyzed to obtain the thrombus formation level. As a result, real-time and quantitative monitoring of the thrombus surface area on the pivot bearing was achieved with an accuracy of 3.6 ± 2.3 mm². In addition, the sensing method using the near-infrared light was not influenced by changes in the oxygen saturation and the hematocrit. It is expected that the developed sensor will be useful for optimal anticoagulation management for long-term extracorporeal circulation therapies.

Hyperspectral imaging of vascular anastomosis associated with blood flow and hemoglobin concentration

The feasibility of optical non-invasive evaluation of the graft function of vascular anastomosis was investigated in vitro using hyperspectral imaging (HSI) in the wavelength range from 500 to 600 nm. A Y-shaped vessel was made using porcine carotid arteries having an inner diameter of 3.5 to 4 mm. The graft vessel was anastomosed at a 45° angle with 8-0 polypropylene suture. Fresh porcine blood at an oxygen saturation of 100% was circulated in the specially designed circuit loop and through the graft or main vessel. The vessels were then irradiated with light, and the reflected light was captured with an HSI camera. The attenuation (A) image at each wavelength (λ) was obtained and the spectral A(λ) image was created. The spectral A(λ) image showed graft patency and changes in the hemoglobin concentration. The A(λ) decreased as the flow rate increased due to the orientation of the red blood cells. The experimental results indicated that imaging of the hemoglobin concentration without distortion from blood flow is possible using two wavelengths: 625 and 770 nm. This method is able to distinguish between the blood flow and changes in hemoglobin concentration. The multispectral and hyperspectral imaging method is useful for the non-invasive evaluation of graft function.

Reaction mechanism of blood coagulation factors in shear flow field

Thrombus formation in blood pumps is a major problem. It has been reported that the shear rate is closely related to thrombus formation in blood pumps; however, the mechanism of blood coagulation in a shear flow field is not yet fully understood. The purpose of this study is to evaluate the effect of shear loading on the reaction of blood coagulation factors quantitatively. Human blood and porcine blood were used as test blood and sheared at 2,880 s-1 for 3 h using a rheometer. After shear loading to the test blood, the activated partial thromboplastin time (APTT) and prothrombin time (PT) of sample plasma were measured using an automated coagulation analyzer. The APTT and PT of mixed plasma containing human blood coagulation factor-deficient plasma and sample plasma were also measured. The APTT and PT of mixed plasma reflected the reaction of the particular blood coagulation factor. Results show that shear loading prolonged the APTT and PT of human sample plasma. Accordingly, the APTT and PT of mixed plasma containing human blood coagulation factor V-deficient plasma and human sample plasma were prolonged after shear loading. Thus, the reaction of human blood coagulation factors was inhibited by specific inhibition of the reaction of human blood coagulation factor V in the shear flow field. The reaction time of porcine blood coagulation factors after shear loading differed from that of human blood coagulation factors. The result suggest the evaluation difficulty of animal blood coagulation reaction, that is, porcine blood coagulation reaction did not fully proceed with clinical reagents due to species specificity.

Real-Time Observation of Thrombus Growth Process in an Impeller of a Hydrodynamically Levitated Centrifugal Blood Pump by Near-Infrared Hyperspectral Imaging

Understanding the thrombus formation in cardiovascular devices such as rotary blood pumps is the most important issue in developing more hemocompatible devices. The objective of this study was to develop a hyperspectral imaging (HSI) method to visualize the thrombus growth process within a rotary blood pump and investigate the optical properties of the thrombus. An in vitro thrombogenic test was conducted using fresh porcine blood and a specially designed hydrodynamically levitated centrifugal blood pump with a transparent bottom. The pump rotating at 3000 rpm circulated the blood at 1.0 L/min. The bottom surface of the pump was illuminated with white light pulsed at the same frequency as the pump rotation, and the backward-scattered light was imaged using the HSI system. Using stroboscopic HSI and an image construction algorithm, dynamic spectral imaging at wavelengths ranging from 608 to 752 nm within the rotating pump was achieved. After completing the experiment, we collected the red thrombus formed in the pump impeller and quantified the thrombus hemoglobin concentration (Hbthrombus ). The spectrum changed around the center of the impeller, and the area of change expanded toward the impeller flow path. The shape corresponded approximately to the shape of the thrombus. The spectrum change indicated that the light scattering derived from red blood cells decreased. The Hbthrombus was 4.7 ± 1.3 g/dL versus a total hemoglobin of 13 ± 0.87 g/dL. The study revealed that Hbthrombus was reduced by the surrounding blood flow.

Development of a photon-cell interactive monte carlo simulation for non-invasive measurement of blood glucose level by Raman spectroscopy

Turbidity variation is one of the major limitations in Raman spectroscopy for quantifying blood components, such as glucose, non-invasively. To overcome this limitation, we have developed a Raman scattering simulation using a photon-cell interactive Monte Carlo (pciMC) model that tracks photon migration in both the extra- and intracellular spaces without relying on the macroscopic scattering phase function and anisotropy factor. The interaction of photons at the plasma-cell boundary of randomly oriented three-dimensionally biconcave red blood cells (RBCs) is modeled using geometric optics. The validity of the developed pciMCRaman was investigated by comparing simulation and experimental results of Raman spectroscopy of glucose level in a bovine blood sample. The scattering of the excitation laser at a wavelength of 785 nm was simulated considering the changes in the refractive index of the extracellular solution. Based on the excitation laser photon distribution within the blood, the Raman photon derived from the hemoglobin and glucose molecule at the Raman shift of 1140 cm(-1) = 862 nm was generated, and the photons reaching the detection area were counted. The simulation and experimental results showed good correlation. It is speculated that pciMCRaman can provide information about the ability and limitations of the measurement of blood glucose level.

Evaluation of erythrocyte flow at a bearing gap in a hydrodynamically levitated centrifugal blood pump

We have developed a hydrodynamically levitated centrifugal blood pump for extracorporeal circulatory support. In the blood pump, a spiral groove bearing was adopted for a thrust bearing. In the spiral groove bearing, separation of erythrocytes and plasma by plasma skimming has been postulated to occur. However, it is not clarified that plasma skimming occurs in a spiral groove bearing. The purpose of this study is to verify whether plasma skimming occurs in the spiral groove bearing of a hydrodynamically levitated centrifugal blood pump. For evaluation of plasma skimming in the spiral groove bearing, an impeller levitation performance test using a laser focus displacement meter and a microscopic visualization test of erythrocyte flow using a high-speed microscope were conducted. Bovine blood diluted with autologous plasma to adjust hematocrit to 1.0% was used as a working fluid. Hematocrit on the ridge region in the spiral groove bearing was estimated using image analysis. As a result, hematocrits on the ridge region with gaps of 45 μm, 31 μm, and 25 μm were calculated as 1.0%, 0.6%, and 0.3%, respectively. Maximum skimming efficiency in this study was calculated as 70% with a gap of 25 μm. We confirmed that separation of erythrocyte and plasma occurred in the spiral groove bearing with decrease in bearing gap in a hydrodynamically levitated centrifugal blood pump.

Evaluation of a Spiral Groove Geometry for Improvement of Hemolysis Level in a Hydrodynamically Levitated Centrifugal Blood Pump

The purpose of this study is to evaluate a spiral groove geometry for a thrust bearing to improve the hemolysis level in a hydrodynamically levitated centrifugal blood pump. We compared three geometric models: (i) the groove width is the same as the ridge width at any given polar coordinate (conventional model); (ii) the groove width contracts inward from 9.7 to 0.5 mm (contraction model); and (iii) the groove width expands inward from 0.5 to 4.2 mm (expansion model). To evaluate the hemolysis level, an impeller levitation performance test and in vitro hemolysis test were conducted using a mock circulation loop. In these tests, the driving conditions were set at a pressure head of 200 mm Hg and a flow rate of 4.0 L/min. As a result of the impeller levitation performance test, the bottom bearing gaps of the contraction and conventional models were 88 and 25 μm, respectively. The impeller of the expansion model touched the bottom housing. In the hemolysis test, the relative normalized index of hemolysis (NIH) ratios of the contraction model in comparison with BPX-80 and HPM-15 were 0.6 and 0.9, respectively. In contrast, the relative NIH ratios of the conventional model in comparison with BPX-80 and HPM-15 were 9.6 and 13.7, respectively. We confirmed that the contraction model achieved a large bearing gap and improved the hemolysis level in a hydrodynamically levitated centrifugal blood pump.

Simultaneous determination of hemolysis and hematocrit in extracorporeal circulation by plasma surface reflectance spectroscopy

To achieve quantitative non-invasive optical diagnosis of blood abnormalities during extracorporeal circulation therapies, plasma surface reflectance spectroscopy was developed by implementing oblique-incidence optical fiber reflectometry on the surface of circulating blood. The reflected light in the wavelength range from 450 to 600 nm changed with respect to the plasma free hemoglobin level and could be used to quantify the free hemoglobin at an accuracy of 5.7 ± 3.5 mg/dL. In contrast, the spectrum did not changed by varying the hematocrit. In the wavelength range from 600 to 800 nm, the obtained spectrum was affected by both the hematocrit change and hemolysis. The linear correlation between the hematocrit value and the spectrum was confirmed at R(2) = 0.99. The feasibility of determining of the hematocrit of arbitrary hemolyzed blood was confirmed. The developed system permits the extraction of the optical characteristics of both plasma and red blood cells without centrifugation. The study establishes non-invasive optical diagnostics capable of analyzing the optical properties of both plasma and red blood cells.

New generation extracorporeal membrane oxygenation with MedTech Mag-Lev, a single-use, magnetically levitated, centrifugal blood pump: preclinical evaluation in calves

We have evaluated the feasibility of a newly developed single-use, magnetically levitated centrifugal blood pump, MedTech Mag-Lev, in a 3-week extracorporeal membrane oxygenation (ECMO) study in calves against a Medtronic Bio-Pump BPX-80. A heparin- and silicone-coated polypropylene membrane oxygenator MERA NHP Excelung NSH-R was employed as an oxygenator. Six healthy male Holstein calves with body weights of about 100 kg were divided into two groups, four in the MedTech group and two in the Bio-Pump group. Under general anesthesia, the blood pump and oxygenator were inserted extracorporeally between the main pulmonary artery and the descending aorta via a fifth left thoracotomy. Postoperatively, both the pump and oxygen flow rates were controlled at 3 L/min. Heparin was continuously infused to maintain the activated clotting time at 200-240 s. All the MedTech ECMO calves completed the study duration. However, the Bio-Pump ECMO calves were terminated on postoperative days 7 and 10 because of severe hemolysis and thrombus formation. At the start of the MedTech ECMO, the pressure drop across the oxygenator was about 25 mm Hg with the pump operated at 2800 rpm and delivering 3 L/min flow. The PO2 of the oxygenator outlet was higher than 400 mm Hg with the PCO2 below 45 mm Hg. Hemolysis and thrombus were not seen in the MedTech ECMO circuits (plasma-free hemoglobin [PFH] < 5 mg/dL), while severe hemolysis (PFH > 20 mg/dL) and large thrombus were observed in the Bio-Pump ECMO circuits. Plasma leakage from the oxygenator did not occur in any ECMO circuits. Three-week cardiopulmonary support was performed successfully with the MedTech ECMO without circuit exchanges. The MedTech Mag-Lev could help extend the durability of ECMO circuits by the improved biocompatible performances.

Quantitative analysis of optical properties of flowing blood using a photon-cell interactive Monte Carlo code: effects of red blood cells' orientation on light scattering

Optical properties of flowing blood were analyzed using a photon-cell interactive Monte Carlo (pciMC) model with the physical properties of the flowing red blood cells (RBCs) such as cell size, shape, refractive index, distribution, and orientation as the parameters. The scattering of light by flowing blood at the He-Ne laser wavelength of 632.8 nm was significantly affected by the shear rate. The light was scattered more in the direction of flow as the flow rate increased. Therefore, the light intensity transmitted forward in the direction perpendicular to flow axis decreased. The pciMC model can duplicate the changes in the photon propagation due to moving RBCs with various orientations. The resulting RBC's orientation that best simulated the experimental results was with their long axis perpendicular to the direction of blood flow. Moreover, the scattering probability was dependent on the orientation of the RBCs. Finally, the pciMC code was used to predict the hematocrit of flowing blood with accuracy of approximately 1.0 HCT%. The photon-cell interactive Monte Carlo (pciMC) model can provide optical properties of flowing blood and will facilitate the development of the non-invasive monitoring of blood in extra corporeal circulatory systems.

Alterations in red blood cell volume and hemoglobin concentration, viscoelastic properties, and mechanical fragility caused by continuous flow pumping in calves

In this study, we have analyzed the changes in mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and the dynamic deformability and mechanical fragility of red blood cells (RBCs) in five male Holstein calves (body weight: 95.6 ± 10.8 kg) whose circulation was partially supported with a novel magnetically levitated extracorporeal centrifugal blood pump MedTech Dispo. One hour after the pumping has started, the MCV increased and the MCHC decreased by 1.064 ± 0.006 and 0.906 ± 0.050 times, respectively, as compared with those of the prepumped blood (P < 0.05). The deformability index L/W, where L and W are the long and short axes of the two-dimensional RBC images, respectively, sheared by a cyclically reversing shear flow increased indicating that the RBCs pumped for 1 h exhibited more elastic characteristics (P < 0.05). In addition, when the pumped blood cells were sheared for 30 min with a uniform shear stress of 25.38 Pa, the hemolysis level decreased dramatically as compared with the control blood, as more fragile RBCs were destroyed by pumping, leaving behind less fragile RBCs. All these characteristics of the RBCs exposed to continuous flow resemble those of young RBCs having larger MCV, lower MCHC, higher elasticity, and lower fragility. In conclusion, during continuous flow pumping, the RBCs having relatively lower threshold for hemolysis to mechanical shear stress generated by continuous flow blood pump (CFBP) are destroyed first and removed from circulation in the early stage of application of CFBP, thus leaving behind less fragile and stronger RBCs.

Photon-cell interactive Monte Carlo model based on the geometric optics theory for photon migration in blood by incorporating both extra- and intracellular pathways

A photon-cell interactive Monte Carlo (pciMC) that tracks photon migration in both the extra- and intracellular spaces is developed without using macroscopic scattering phase functions and anisotropy factors, as required for the conventional Monte Carlos (MCs). The interaction of photons at the plasma-cell boundary of randomly oriented 3-D biconcave red blood cells (RBCs) is modeled using the geometric optics. The pciMC incorporates different photon velocities from the extra- to intracellular space, whereas the conventional MC treats RBCs as points in the space with a constant velocity. In comparison to the experiments, the pciMC yielded the mean errors in photon migration time of 9.8±6.8 and 11.2±8.5% for suspensions of small and large RBCs (RBC(small), RBC(large)) averaged over the optically diffusing region from 2000 to 4000 μm, while the conventional random walk Monte Carlo simulation gave statistically higher mean errors of 19.0±5.8 ( p < 0.047) and 21.7±19.1% (p < 0.055), respectively. The gradients of optical density in the diffusing region yielded statistically insignificant differences between the pciMC and experiments with the mean errors between them being 1.4 and 0.9% in RBC(small) and RBC(larger), respectively. The pciMC based on the geometric optics can be used to accurately predict photon migration in the optically diffusing, turbid medium.

Glucose depletion enhances sensitivity to shear stress-induced mechanical damage in red blood cells by rotary blood pumps

The metabolic process in red blood cells (RBCs) is anaerobic. The life-dependent adenosine triphosphate (ATP) for survival of cells is produced through glycolytic process. The aim of the study was to evaluate the effects of the glucose level on the mean corpuscular volume, mean corpuscular hemoglobin concentration, and hemolysis rate during hemolysis study by rotary blood pumps. The shear stress generated by rotary blood pumps may enhance glucose utilization by RBCs with depletion of glucose affecting ATP production and, consequently, cell size, shape, and morphology. The shear stress increases metabolism of RBCs consuming more energy ATP which is produced anaerobically from glycolytic process. Hence, in the closed circuit testing of rotary blood pumps, depletion of glucose might occur after prolonged pumping, which in turn affects metabolic process of RBCs by changing their size, shape, and morphology. It is thus suggested to monitor and control the glucose level of the fluid that suspends RBCs depending on the study duration.

Application of a magnetic fluid seal to rotary blood pumps

A magnetic fluid seal enables mechanical contact-free rotation of a shaft without frictional heat and material wear and hence has excellent durability. However, the durability of a magnetic fluid seal decreases in liquid. The life of a seal applied to a rotary blood pump is not known. We have developed a magnetic fluid seal that has a shield mechanism minimizing the influence of the rotary pump on the magnetic fluid. The developed magnetic fluid seal worked for over 286 days in a continuous flow condition, for 24 days (on-going) in a pulsatile flow condition and for 24 h (electively terminated) in blood flow. The magnetic fluid seal is promising as a shaft seal for rotary blood pumps.

Deformability of Red Blood Cells and Its Relation to Blood Trauma in Rotary Blood Pumps

In this study, mechanical trauma to red blood cells was evaluated by conventional hemolysis test and a newly developed cyclically reversing shear flow generator. The fresh porcine blood obtained from a local slaughterhouse was subjected to the conventional hemolysis test using a commercial centrifugal blood pump for the duration of 8 h. The measurements consisted of (i) plasma-free hemoglobin based on the standard optical measurement and (ii) the deformability of red blood cells (RBCs) using a cyclically reversing shear flow generator and microscope image acquisition system. The deformability of RBCs was expressed by the L/W value where L and W were the longer and shorter axes of the elongated RBCs' images. Although the plasma-free hemoglobin level increased with the pumping duration, the L/W remained unchanged for the duration of 8 h of pumping to indicate no alteration in the deformability. It was speculated that (i) although RBCs might have been circulated for so many times through the test pump, after each exposure to mechanical stress, RBCs might have recovered, and net effect due to shear stress-exposure time might have been small; and (ii) RBCs' deformability might be maintained near normal until sudden burst or membrane rupture, or the hemoglobin might have continuously leaked through the pores of the thinned membrane created by the mechanical stress. The deformability testing under a fluctuating shear flow could be a new method to quantify subhemolytic mechanical damage that has been accumulated in the RBCs' membrane and that may not be assessed by the conventional hemolysis test.

A Hydrodynamically Suspended, Magnetically Sealed Mechanically Noncontact Axial Flow Blood Pump: Design of a Hydrodynamic Bearing

To overcome the drive shaft seal and bearing problem in rotary blood pumps, a hydrodynamic bearing, a magnetic fluid seal, and a brushless direct current (DC) motor were employed in an axial flow pump. This enabled contact-free rotation of the impeller without material wear. The axial flow pump consisted of a brushless DC motor, an impeller, and a guide vane. The motor rotor was directly connected to the impeller by a motor shaft. A hydrodynamic bearing was installed on the motor shaft. The motor and the hydrodynamic bearing were housed in a cylindrical casing and were waterproofed by a magnetic fluid seal, a mechanically noncontact seal. Impeller shaft displacement was measured using a laser sensor. Axial and radial displacements of the shaft were only a few micrometers for motor speed up to 8500 rpm. The shaft did not make contact with the bearing housing. A flow of 5 L/min was obtained at 8000 rpm at a pressure difference of 100 mm Hg. In conclusion, the axial flow blood pump consisting of a hydrodynamic bearing, a magnetic fluid seal, and a brushless DC motor provided contact-free rotation of the impeller without material wear.