title: LVAD Outflow Graft Angle and Thrombosis Risk.
abstract: This study quantifies thrombogenic potential (TP) of a wide range of left ventricular assist device (LVAD) outflow graft anastomosis angles through state-of-the-art techniques: 3D imaged-based patient-specific models created via virtual surgery and unsteady computational fluid dynamics with Lagrangian particle tracking. This study aims at clarifying the influence of a single parameter (outflow graft angle) on the thrombogenesis associated with flow patterns in the aortic root after LVAD implantation. This is an important and poorly-understood aspect of LVAD therapy, because several studies have shown strong inter and intrapatient thrombogenic variability and current LVAD implantation strategies do not incorporate outflow graft angle optimization. Accurate platelet-level investigation, enabled by statistical treatment of outliers in Lagrangian particle tracking, demonstrates a strong influence of outflow graft anastomoses angle on thrombogenicity (platelet residence times and activation state characterized by shear stress accumulation) with significantly reduced TP for acutely-angled anastomosed outflow grafts. The methodology presented in this study provides a device-neutral platform for conducting comprehensive thrombogenicity evaluation of LVAD surgical configurations, empowering optimal patient-focused surgical strategies for long-term treatment and care for advanced heart failure patients.
authors.affiliation: From the *Department of Mechanical Engineering, University of Washington, Seattle, Washington; †Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin; ‡Division of Cardiology, University of Washington, Seattle, Washington; and §Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aliseda
authors.forename: Venkat Keshav
authors.initials: VK
authors.lastname: Chivukula
authors.forename: Patrick
authors.initials: P
authors.lastname: Mcgah
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Prisco
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Beckman
authors.forename: Guilherme J M
authors.initials: GJ
authors.lastname: Garcia
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.forename: Claudius
authors.initials: C
authors.lastname: Mahr
mesh_terms: D000328:Adult; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D012306:Risk; D013927:Thrombosis / Q000209:etiology*