title: Computational analysis of aortic hemodynamics during total and partial extracorporeal membrane oxygenation and intra-aortic balloon pump support.
abstract: OBJECTIVE
  The extracorporeal membrane oxygenation (ECMO) is a temporary, but prolonged circulatory support for cardiopulmonary failure. Clinical evidence suggests that pulsed flow is healthier than non pulsatile perfusion. The aim of this study was to computationally evaluate the effects of total and partial ECMO assistance and pulsed flow on hemodynamics in a patient-specific aorta model.
  
  
  METHODS
  The pulsatility was obtained by means of the intra-aortic balloon pump (IABP), and two different cases were investigated, considering a cardiac output (CO) of 5 L/min: Case A - total assistance - the whole flow delivered through the ECMO arterial cannula; Case B - partial assistance - flow delivered half through the cannula and half through the aorta. Computational fluid dynamic (CFD) analysis was carried out using the multiscale approach to couple the 3D aorta model with the lumped parameter model (resistance boundary condition).
  
  
  RESULTS
  In case A pulsatility followed the balloon radius change, while in case B it was mostly influenced by the cardiac one. Furthermore, during total assistance, a blood stagnation occurred in the ascending aorta; in the case of partial assistance, the flow was orderly when the IABP was on and was chaotic when the balloon was off. Moreover, the mean arterial pressure (MAP) was higher in case B. The wall shear stress was worse in ascending aorta in case A.
  
  
  CONCLUSIONS
  Partial support is hemodynamically advisable.
authors.affiliation: Bioengineering Group, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Caruso
authors.affiliation: Bioengineering Group, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors.forename: Vera
authors.initials: V
authors.lastname: Gramigna
authors.affiliation: Cardiothoracic Surgery, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
authors.affiliation: Bioengineering Group, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors.forename: Gionata
authors.initials: G
authors.lastname: Fragomeni
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D002302:Cardiac Output; D003198:Computer Simulation; D015199:Extracorporeal Membrane Oxygenation; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D013314:Stress, Mechanical