Blood damage in Left Ventricular Assist Devices: Pump thrombosis or system thrombosis?

Matteo Selmi, Wei Che Chiu, Venkat Keshav Chivukula, Giulio Melisurgo, Jennifer Ann Beckman, Claudius Mahr, Alberto Aliseda, Emiliano Votta, Alberto Redaelli, Marvin J Slepian, Danny Bluestein, Federico Pappalardo, Filippo Consolo

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Introduction: Despite significant technical advancements in the design and manufacture of Left Ventricular Assist Devices, post-implant thrombotic and thromboembolic complications continue to affect long-term outcomes. Previous efforts, aimed at optimizing pump design as a means of reducing supraphysiologic shear stresses generated within the pump and associated prothrombotic shear-mediated platelet injury, have only partially altered the device hemocompatibility. Methods: We examined hemodynamic mechanisms that synergize with hypershear within the pump to contribute to the thrombogenic potential of the overall Left Ventricular Assist Device system. Results: Numerical simulations of blood flow in differing regions of the Left Ventricular Assist Device system, that is the diseased native left ventricle, the pump inflow cannula, the impeller, the outflow graft and the anastomosed downstream aorta, reveal that prothrombotic hemodynamic conditions might occur at these specific sites. Furthermore, we show that beyond hypershear, additional hemodynamic abnormalities exist within the pump, which may elicit platelet activation, such as recirculation zones and stagnant platelet trajectories. We also provide evidences that particular Left Ventricular Assist Device implantation configurations and specific post-implant patient management strategies, such as those allowing aortic valve opening, are more hemodynamically favorable and reduce the thrombotic risk. Conclusion: We extend the perspective of pump thrombosis secondary to the supraphysiologic shear stress environment of the pump to one of Left Ventricular Assist Device system thrombosis, raising the importance of comprehensive characterization of the different prothrombotic risk factors of the total system as the target to achieve enhanced hemocompatibility and improved clinical outcomes.

Original languageEnglish (US)
JournalInternational Journal of Artificial Organs
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • hemodynamics
  • Left Ventricular Assist Device
  • platelet activation
  • shear stress
  • thrombosis

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

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    Selmi, M., Chiu, W. C., Chivukula, V. K., Melisurgo, G., Beckman, J. A., Mahr, C., Aliseda, A., Votta, E., Redaelli, A., Slepian, M. J., Bluestein, D., Pappalardo, F., & Consolo, F. (Accepted/In press). Blood damage in Left Ventricular Assist Devices: Pump thrombosis or system thrombosis? International Journal of Artificial Organs. https://doi.org/10.1177/0391398818806162