Abstract
PurposeThis computational fluid dynamics study investigates the necessity of incorporating heart failure severity in the preoperative planning of left ventricular assist device (LVAD) configurations, as it is often omitted from studies on LVAD performance.MethodsA parametric study was conducted examining a common range of LVAD to aortic root flow ratios (LVAD/AR-FR). A normal aortic root waveform was scaled by 5–30% in increments of 5% to represent the common range of flow pumped by the left ventricle for different levels of heart failure. A constant flow rate from the cannula compensated for the severity of heart failure in order to maintain normal total aortic flow rate.ResultsThe results show that LVAD/AR-FR can have a significant but irregular impact on the perfusion and shear stress-related haemodynamic parameters of the subclavian and carotid arteries. Furthermore, it is found that a larger portion of the flow is directed towards the thoracic aorta at the expense of the carotid and subclavian arteries, regardless of LVAD/AR-FR.ConclusionThe irregular behaviour found in the subclavian and carotid arteries highlights the necessity of including the LVAD/AR-FR in the preoperative planning of an LVAD configuration, in order to accurately improve the effects on the cardiovascular system post implantation.
Highlights
Left ventricular assist devices (LVADs) are an established form of treatment for patients with heart failure and result in clear survival benefit
There is a scope for work that defines the necessity of incorporating the LVAD/aortic root (AR)-flow ratio (FR) into the preoperative planning of an LVAD configuration, in order to accurately improve the effects on the cardiovascular system post implantation
These parameters are used as a tool to study whether the haemodynamics are favourable or detrimental to the health of the patients with an LVAD and to help identify some characteristics of disturbed flow that are of pathobiological importance
Summary
Left ventricular assist devices (LVADs) are an established form of treatment for patients with heart failure and result in clear survival benefit. There is currently a wide range of research surrounding the optimization of the LVAD outflow cannula design to address this problem, there appears to be no emphasis on the haemodynamic effect of the flow ratio (FR) between the LVAD cannula outlet and aortic root (LVAD/AR-FR). This ratio is often omitted from studies on LVAD performance. Valuable insight may be gained by incorporating patient-specific LVAD/AR-FRs into preoperative LVAD configuration planning using simulation technologies
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