TY - JOUR
T1 - Effect of RVAD cannulation length on right ventricular thrombosis risk
T2 - An in silico investigation
AU - Thum, Kar Ying
AU - Liao, Sam
AU - Šeman, Michael
AU - Khamooshi, Mehrdad
AU - Carberry, Josie
AU - McGiffin, David
AU - Gregory, Shaun D.
N1 - Funding Information:
Open Access funding enabled and organized by CAUL and its Member Institutions. This work was supported by the Monash Institute of Medical Engineering and the National Health and Medical Research Council (NHMRC) (APP2002567). A/Prof. Shaun D Gregory was supported by an NHMRC Investigator Grant (2016995) and Fellowship (106675) from the National Heart Foundation of Australia.
Publisher Copyright:
© The Author(s) 2024.
PY - 2024/6
Y1 - 2024/6
N2 - Left ventricular assist devices (LVADs) have been used off-label as long-term support of the right heart due to the lack of a clinically approved durable right VAD (RVAD). Whilst various techniques to reduce RVAD inflow cannula protrusion have been described, the implication of the protrusion length on right heart blood flow and subsequent risk of thrombosis remains poorly understood. This study investigates the influence of RVAD diaphragmatic cannulation length on right ventricular thrombosis risk using a patient-specific right ventricle in silico model validated with particle image velocimetry. Four cannulation lengths (5, 10, 15 and 25 mm) were evaluated in a one-way fluid–structure interaction simulation with boundary conditions generated from a lumped parameter model, simulating a biventricular supported condition. Simulation results demonstrated that the 25-mm cannulation length exhibited a lower thrombosis risk compared to 5-, 10- and 15-mm cannulation lengths due to improved flow energy distribution (25.2%, 24.4% and 17.8% increased), reduced stagnation volume (72%, 68% and 49% reduction), better washout rate (13.0%, 11.6% and 9.1% faster) and lower blood residence time (6% reduction). In the simulated scenario, our findings suggest that a longer RVAD diaphragmatic cannulation length may be beneficial in lowering thrombosis risk; however, further clinical studies are warranted.
AB - Left ventricular assist devices (LVADs) have been used off-label as long-term support of the right heart due to the lack of a clinically approved durable right VAD (RVAD). Whilst various techniques to reduce RVAD inflow cannula protrusion have been described, the implication of the protrusion length on right heart blood flow and subsequent risk of thrombosis remains poorly understood. This study investigates the influence of RVAD diaphragmatic cannulation length on right ventricular thrombosis risk using a patient-specific right ventricle in silico model validated with particle image velocimetry. Four cannulation lengths (5, 10, 15 and 25 mm) were evaluated in a one-way fluid–structure interaction simulation with boundary conditions generated from a lumped parameter model, simulating a biventricular supported condition. Simulation results demonstrated that the 25-mm cannulation length exhibited a lower thrombosis risk compared to 5-, 10- and 15-mm cannulation lengths due to improved flow energy distribution (25.2%, 24.4% and 17.8% increased), reduced stagnation volume (72%, 68% and 49% reduction), better washout rate (13.0%, 11.6% and 9.1% faster) and lower blood residence time (6% reduction). In the simulated scenario, our findings suggest that a longer RVAD diaphragmatic cannulation length may be beneficial in lowering thrombosis risk; however, further clinical studies are warranted.
KW - BiVAD
KW - Computational fluid dynamics (CFD)
KW - Flow modelling
KW - One-way fluid–structure interaction (FSI)
KW - Right heart failure
KW - Right ventricle diaphragmatic implantation
UR - http://www.scopus.com/inward/record.url?scp=85186257404&partnerID=8YFLogxK
U2 - 10.1007/s10439-024-03474-4
DO - 10.1007/s10439-024-03474-4
M3 - Article
C2 - 38418690
AN - SCOPUS:85186257404
SN - 0090-6964
VL - 52
SP - 1604
EP - 1616
JO - Annals of Biomedical Engineering
JF - Annals of Biomedical Engineering
IS - 6
ER -