title: High fidelity computational simulation of thrombus formation in Thoratec HeartMate II continuous flow ventricular assist device.
abstract: Continuous flow ventricular assist devices (cfVADs) provide a life-saving therapy for severe heart failure. However, in recent years, the incidence of device-related thrombosis (resulting in stroke, device-exchange surgery or premature death) has been increasing dramatically, which has alarmed both the medical community and the FDA. The objective of this study was to gain improved understanding of the initiation and progression of thrombosis in one of the most commonly used cfVADs, the Thoratec HeartMate II. A computational fluid dynamics simulation (CFD) was performed using our recently updated mathematical model of thrombosis. The patterns of deposition predicted by simulation agreed well with clinical observations. Furthermore, thrombus accumulation was found to increase with decreased flow rate, and can be completely suppressed by the application of anticoagulants and/or improvement of surface chemistry. To our knowledge, this is the first simulation to explicitly model the processes of platelet deposition and thrombus growth in a continuous flow blood pump and thereby replicate patterns of deposition observed clinically. The use of this simulation tool over a range of hemodynamic, hematological, and anticoagulation conditions could assist physicians to personalize clinical management to mitigate the risk of thrombosis. It may also contribute to the design of future VADs that are less thrombogenic.
authors.affiliation: Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, 15213, USA.
authors.forename: Wei-Tao
authors.initials: WT
authors.lastname: Wu
authors.affiliation: Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, Jilin University, Changchun 130012, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Yang
authors.affiliation: Advanced Design Optimization, Irvine, CA, 92618, USA.
authors.forename: Jingchun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Mechanical Engineering, Northeastern University, Boston, MA, 02115, USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Aubry
authors.affiliation: U. S. Department of Energy, National Energy Technology Laboratory (NETL), PA, 15236, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Massoudi
authors.affiliation: Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, 15213, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Antaki
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003198:Computer Simulation; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D011673:Pulsatile Flow; D013499:Surface Properties; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000925:Anticoagulants