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A Computational Investigation of the Effects of Temporal Synchronization of Left Ventricular Assist Device Speed Modulation with the Cardiac Cycle on Intraventricular Hemodynamics

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Abstract

Patients with advanced heart failure are implanted with a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy. Despite advances in pump design, the risk of stroke remains high. LVAD implantation significantly alters intraventricular hemodynamics, where regions of stagnation or elevated shear stresses promote thrombus formation. Third generation pumps incorporate a pulsatility mode that modulates rotational speed of the pump to enhance in-pump washout. We investigated how the timing of the pulsatility mode with the cardiac cycle affects intraventricular hemodynamic factors linked to thrombus formation. Computational fluid dynamics simulations with Lagrangian particle tracking to model platelet behavior in a patient-specific left ventricle captured altered intraventricular hemodynamics due to LVAD implantation. HeartMate 3 incorporates a pulsatility mode that modulates the speed of the pump every two seconds. Four different timings of this pulsatility mode with respect to the cardiac cycle were investigated. A strong jet formed between the mitral valve and inflow cannula. Blood stagnated in the left ventricular outflow tract beneath a closed aortic valve, in the near-wall regions off-axis of the jet, and in a large counterrotating vortex near the anterior wall. Computational results showed good agreement with particle image velocimetry results. Synchronization of the pulsatility mode with peak systole decreased stasis, reflected in the intraventricular washout of virtual contrast and Lagrangian particles over time. Temporal synchronization of HeartMate 3 pulsatility with the cardiac cycle reduces intraventricular stasis and could be beneficial for decreasing thrombogenicity.

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Funding

This work was funded by the National Science Foundation Graduate Research Fellowship Program (NSF GRFP) AHRQ (Grant No. 1 R18 HS 026690; Funder ID: 10.13039/100000133). Experimental work has been financially supported by the Locke Trust through a gift to the Division of Cardiology of the University of Washington and the American Heart Association via a Postdoctoral fellowship (19POST34450082). This work was facilitated through the use of advanced computational, storage, and networking infrastructure provided by the Hyak supercomputer system and funded by the Student Technology Fund at the University of Washington.

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Washington, Seattle, WA, USA

    Angela Straccia, Michael C. Barbour & Alberto Aliseda

  2. INSERM U1059 Sainboise, Mines Saint-Étienne, Saint-Étienne, France

    Fanette Chassagne

  3. Division of Cardiology, University of Washington, Seattle, WA, USA

    Jennifer Beckman

  4. Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, TX, USA

    Song Li & Claudius Mahr

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  1. Angela Straccia
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  2. Fanette Chassagne
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Correspondence to Angela Straccia.

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Appendices

Appendix 1

See Figs. 9 and 10.

Fig. 9
figure 9

Flow rates over time for four timings of the pulsatility mode synchronized with the cardiac cycle

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Fig. 10
figure 10

Bland-Altman plots of differences in CFD and PIV velocity magnitude for speed modulation synchronized with systole in the posterior–anterior and left–right views a at peak diastole, b at peak systole, c at low RPM and d at high RPM in the pulsatility mode with the median (labeled in bold face) and 95% confidence intervals (labeled with italics) identified with dashed lines

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Straccia, A., Chassagne, F., Barbour, M.C. et al. A Computational Investigation of the Effects of Temporal Synchronization of Left Ventricular Assist Device Speed Modulation with the Cardiac Cycle on Intraventricular Hemodynamics. Ann Biomed Eng (2024). https://doi.org/10.1007/s10439-024-03489-x

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