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      Effects of a Short-Term Left Ventricular Assist Device on Hemodynamics in a Heart Failure Patient-Specific Aorta Model: A CFD Study

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          Abstract

          Patients with heart failure (HF) or undergoing cardiogenic shock and percutaneous coronary intervention require short-term cardiac support. Short-term cardiac support using a left ventricular assist device (LVAD) alters the pressure and flows of the vasculature by enhancing perfusion and improving the hemodynamic performance for the HF patients. However, due to the position of the inflow and outflow of the LVAD, the local hemodynamics within the aorta is altered with the LVAD support. Specifically, blood velocity, wall shear stress, and pressure difference are altered within the aorta. In this study, computational fluid dynamics (CFD) was used to elucidate the effects of a short-term LVAD for hemodynamic performance in a patient-specific aorta model. The three-dimensional (3D) geometric models of a patient-specific aorta and a short-term LVAD, Impella CP, were created. Velocity, wall shear stress, and pressure difference in the patient-specific aorta model with the Impella CP assistance were calculated and compared with the baseline values of the aorta without Impella CP support. Impella CP support augmented cardiac output, blood velocity, wall shear stress, and pressure difference in the aorta. The proposed CFD study could analyze the quantitative changes in the important hemodynamic parameters while considering the effects of Impella CP, and provide a scientific basis for further predicting and assessing the effects of these hemodynamic signals on the aorta.

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          Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

          Emelia Benjamin, Michael Blaha, Stephanie Chiuve … (2017)
          Circulation, 135(10)
          Article 0 comments Cited 1408 times – based on 0 reviews     Review now
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            Two-equation eddy-viscosity turbulence models for engineering applications

            F. R. Menter (1994)
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              Advanced heart failure treated with continuous-flow left ventricular assist device.

              V Conte, Stuart D. Russell, D Farrar … (2009)
              Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatile-flow left ventricular assist devices as compared with medical therapy. New continuous-flow devices are smaller and may be more durable than the pulsatile-flow devices. In this randomized trial, we enrolled patients with advanced heart failure who were ineligible for transplantation, in a 2:1 ratio, to undergo implantation of a continuous-flow device (134 patients) or the currently approved pulsatile-flow device (66 patients). The primary composite end point was, at 2 years, survival free from disabling stroke and reoperation to repair or replace the device. Secondary end points included survival, frequency of adverse events, the quality of life, and functional capacity. Preoperative characteristics were similar in the two treatment groups, with a median age of 64 years (range, 26 to 81), a mean left ventricular ejection fraction of 17%, and nearly 80% of patients receiving intravenous inotropic agents. The primary composite end point was achieved in more patients with continuous-flow devices than with pulsatile-flow devices (62 of 134 [46%] vs. 7 of 66 [11%]; P<0.001; hazard ratio, 0.38; 95% confidence interval, 0.27 to 0.54; P<0.001), and patients with continuous-flow devices had superior actuarial survival rates at 2 years (58% vs. 24%, P=0.008). Adverse events and device replacements were less frequent in patients with the continuous-flow device. The quality of life and functional capacity improved significantly in both groups. Treatment with a continuous-flow left ventricular assist device in patients with advanced heart failure significantly improved the probability of survival free from stroke and device failure at 2 years as compared with a pulsatile device. Both devices significantly improved the quality of life and functional capacity. (ClinicalTrials.gov number, NCT00121485.) 2009 Massachusetts Medical Society
              Article 0 comments Cited 173 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Physiol
                Journal ID (iso-abbrev): Front Physiol
                Journal ID (publisher-id): Front. Physiol.
                Title: Frontiers in Physiology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-042X
                Publication date (Electronic): 21 September 2021
                Publication date Collection: 2021
                Volume: 12
                Electronic Location Identifier: 733464
                Affiliations
                [1] 1School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology , Dalian, China
                [2] 2Department of Cardiovascular Computed Tomography (CT) Examination, The First Affiliated Hospital of Dalian Medical University , Dalian, China
                [3] 3Department of Bioengineering, University of Louisville , Louisville, KY, United States
                [4] 4Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
                Author notes

                Edited by: Youjun Liu, Beijing University of Technology, China

                Reviewed by: Shengzhang Wang, Fudan University, China; Zengsheng Chen, Beihang University, China

                *Correspondence: Yong Luan cclyyly@ 123456163.com

                This article was submitted to Computational Physiology and Medicine, a section of the journal Frontiers in Physiology

                Article
                DOI: 10.3389/fphys.2021.733464
                PMC ID: 8491745
                PubMed ID: 34621186
                SO-VID: 94555ac6-c248-4b06-8639-e0f568068df8
                Copyright © Copyright © 2021 Wang, Wang, Peng, Huo, Yang, Giridharan, Luan and Qin.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 30 June 2021
                Date accepted : 20 August 2021
                Page count
                Figures: 10, Tables: 0, Equations: 6, References: 46, Pages: 13, Words: 6773
                Categories
                Subject: Physiology
                Subject: Original Research

                ScienceOpen disciplines: Anatomy & Physiology
                Keywords: cfd,hemodynamic performance,patient-specific aorta model,left ventricular assist device,heart failure
                Data availability:
                ScienceOpen disciplines: Anatomy & Physiology
                Keywords: cfd, hemodynamic performance, patient-specific aorta model, left ventricular assist device, heart failure

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