Innovative Modeling Techniques and 3D Printing in Patients with Left Ventricular Assist Devices: A Bridge from Bench to Clinical Practice.

Rishi Thaker,Mahwash Kassi,Hernan G Marcos-Abdala,Raquel Araujo-Gutierrez,Tanushree Agrawal,Nadia Fida

doi:10.3390/jcm8050635

Rishi Thaker, Mahwash Kassi + Show 4 more

Open Access

https://doi.org/10.3390/jcm8050635

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Abstract

Left ventricular assist devices (LVAD) cause altered flow dynamics that may result in complications such as stroke, pump thrombosis, bleeding, or aortic regurgitation. Understanding altered flow dynamics is important in order to develop more efficient and durable pump configurations. In patients with LVAD, hemodynamic assessment is limited to imaging techniques such as echocardiography which precludes detailed assessment of fluid dynamics. In this review article, we present some innovative modeling techniques that are often used in device development or for research purposes, but have not been utilized clinically. Computational fluid dynamic (CFD) modeling is based on computer simulations and particle image velocimetry (PIV) employs ex vivo models that helps study fluid characteristics such as pressure, shear stress, and velocity. Both techniques may help elaborate our understanding of complications that occur with LVAD and could be potentially used in the future to troubleshoot LVAD-related alarms. These techniques coupled with 3D printing may also allow for patient-specific device implants, lowering the risk of complications increasing device durability.

Highlights

Left ventricular assist device (LVAD) provides a bridge to transplant or destination therapy for patients with end-stage heart failure or low cardiac output
The second-generation LVADs, like the HeartMate II (Thoratec, Pleasanton, CA, USA), used axial impellers to deliver flow augmentation, but thrombotic and bleeding complications appeared to become more common in this iteration [1,2]
The latest device, HeartMate 3, demonstrated superiority in mortality, disabling stroke, or reoperation to replace or remove a malfunctioning device compared to second-generation LVADs in the MOMENTUM trial [3]

Summary

Introduction

Left ventricular assist device (LVAD) provides a bridge to transplant or destination therapy for patients with end-stage heart failure or low cardiac output. Third-generation centrifugal flow LVAD, the HeartWare HVAD (HeartWare Inc., Framingham, MA, USA) are smaller, frictionless, pulsatile, allow pericardial placement, and have fewer complications of in-pump thrombosis [3]. Several LVAD CFD studies have evaluated this interaction of flow from outflow cannula with the aorta.

Results

Conclusion