title: Numerical investigation of the effect of cannula placement on thrombosis.
abstract: Despite the rapid advancement of left ventricular assist devices (LVADs), adverse events leading to deaths have been frequently reported in patients implanted with LVADs, including bleeding, infection, thromboembolism, neurological dysfunction and hemolysis. Cannulation forms an important component with regards to thrombus formation in assisted patients by varying the intraventricular flow distribution in the left ventricle (LV). To investigate the correlation between LVAD cannula placement and potential for thrombus formation, detailed analysis of the intraventricular flow field was carried out in the present study using a two way fluid structure interaction (FSI), axisymmetric model of a passive LV incorporating an inflow cannula. Three different cannula placements were simulated, with device insertion near the LV apex, penetrating one-fourth and mid-way into the LV long axis. The risk of thrombus formation is assessed by analyzing the intraventricular vorticity distribution and its associated vortex intensity, amount of stagnation flow in the ventricle as well as the level of wall shear stress. Our results show that the one-fourth placement of the cannula into the LV achieves the best performance in reducing the risk of thrombus formation. Compared to cannula placement near the apex, higher vortex intensity is achieved at the one-fourth placement, thus increasing wash out of platelets at the ventricular wall. One-fourth LV penetration produced negligible stagnation flow region near the apical wall region, helping to reduce platelet deposition on the surface of the cannula and the ventricular wall.
authors.affiliation: Faculty of Biomedical Engineering, University of Malaya, Malaysia University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: ChiWei
authors.initials: C
authors.lastname: Ong
authors.forename: Socrates
authors.initials: S
authors.lastname: Dokos
authors.forename: BeeTing
authors.initials: B
authors.lastname: Chan
authors.forename: Einly
authors.initials: E
authors.lastname: Lim
authors.forename: Amr
authors.initials: A
authors.lastname: Al Abed
authors.forename: Noor Azuan
authors.initials: NA
authors.lastname: Bin Abu Osman
authors.forename: Suhaini
authors.initials: S
authors.lastname: Kadiman
authors.forename: Nigel H
authors.initials: NH
authors.lastname: Lovell
mesh_terms: D002404:Catheterization; D006801:Humans; D012307:Risk Factors; D013927:Thrombosis / Q000503:physiopathology*