Multi-constituent simulation of thrombus formation at LVAD inlet cannula connection: Importance of Virchow’s triad,Artificial Organs

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Multi-constituent simulation of thrombus formation at LVAD inlet cannula connection: Importance of Virchow’s triad
Artificial Organs ( IF 2.2 ) Pub Date : 2021-03-08 , DOI: 10.1111/aor.13949
Rodrigo Méndez Rojano ₁ , Mansur Zhussupbekov ₁ , James F Antaki ₁

Affiliation

As pump thrombosis is reduced in current-generation ventricular assist devices (VAD), adverse events such as bleeding or stroke remain at unacceptable rates. Thrombosis around the VAD inlet cannula (IC) has been highlighted as a possible source of stroke events. Recent computational fluid dynamics (CFD) studies have attempted to characterize the thrombosis risk of different IC-ventricle configurations. However, purely CFD simulations relate thrombosis risk to ad hoc criteria based on flow characteristics, with little consideration of biochemical factors. This study investigates the genesis of IC thrombosis including two elements of the Virchow's triad: endothelial injury and hypercoagulability. To this end a multi-scale thrombosis simulation that includes platelet activity and coagulation reactions was performed. Our results show significant thrombin formation in stagnation regions (|u| < 0.005 m/s) close to the IC wall. In addition, high shear-mediated platelet activation was observed over the leading-edge tip of the cannula. The current study reveals the importance of biochemical factors to the genesis of thrombosis at the ventricular-cannula junction in a perioperative state. This study is a first step toward the long-term objective of including clinically relevant pharmacological kinetics such as heparin or aspirin in simulations of inflow cannula thrombosis.

中文翻译：

LVAD 入口插管连接处血栓形成的多成分模拟：Virchow 三元组的重要性

随着新一代心室辅助装置 (VAD) 中泵血栓形成的减少，出血或中风等不良事件的发生率仍处于不可接受的水平。VAD 入口插管 (IC) 周围的血栓形成已被强调为中风事件的可能来源。最近的计算流体动力学 (CFD) 研究试图描述不同 IC 心室配置的血栓形成风险。然而，纯粹的 CFD 模拟将血栓形成风险与基于流动特性的临时标准联系起来，很少考虑生化因素。本研究调查了 IC 血栓形成的起源，包括 Virchow 三联征的两个要素：内皮损伤和高凝状态。为此，进行了包括血小板活性和凝血反应在内的多尺度血栓形成模拟。你| < 0.005 m/s) 靠近 IC 壁。此外，在套管的前沿尖端观察到高剪切介导的血小板活化。目前的研究揭示了生化因素对围手术期心室插管连接处血栓形成的重要性。这项研究是朝着将临床相关药理学动力学（例如肝素或阿司匹林）纳入流入套管血栓形成模拟的长期目标迈出的第一步。

更新日期：2021-03-08

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