Effect of RVAD cannulation length on right ventricular thrombosis risk: An in silico investigation

Kar Ying Thum, Sam Liao, Michael Šeman, Mehrdad Khamooshi, Josie Carberry, David McGiffin, Shaun D. Gregory

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1604–1616
Number of pages13
JournalAnnals of Biomedical Engineering
Volume52
Issue number6
DOIs
Publication statusPublished - Jun 2024

Keywords

  • BiVAD
  • Computational fluid dynamics (CFD)
  • Flow modelling
  • One-way fluid–structure interaction (FSI)
  • Right heart failure
  • Right ventricle diaphragmatic implantation

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