Optical Dynamic Analysis of Thrombus Inside a Centrifugal Blood Pump During Extracorporeal Mechanical Circulatory Support in a Porcine Model.
Complications due to pump thrombus remain the weak point of mechanical circulatory support (MCS), such as the use of a left ventricular assist device (LVAD) or extracorporeal membrane oxygenation, leading to poor outcomes. Hyperspectral imaging (HSI) is an effective imaging method using a hyperspectral (HS) camera, which comprises a spectrophotometer and a charge-coupled device camera to discriminate thrombus from whole blood. Animal experiments were conducted to analyze dynamic imaging of thrombus inside a prototype of a hydrodynamically levitated centrifugal blood pump using an HSI system. Six pigs were divided into a venous circulation group (n = 3) and an arterial circulation group (n = 3). Inflow and outflow cannulae were inserted into the jugular veins in the venous circulation group. The latter simulated an LVAD application. To create thrombogenic conditions, pump flow was maintained at 1 L/min without anticoagulation. An image of the bottom surface of the pump was captured by the HS camera every 4 nm over the wavelength range of 608-752 nm. Real-time dynamic images of the inside of the pump were displayed on the monitor. Appearance of an area displaying thrombus was detected within 24 h after the start of the circulation in every experiment. This imaging system also succeeded in determining the origins of pump thrombus: from inside the pump in two cases, and from outside in four cases. Two main possible sources of pump thrombus originating outside the pump were identified on autopsy: wedge thrombus around the inflow cannula; and string-like thrombus at the junction between the pump inlet and circuit tube. The results of this study from close observation of the changing appearance of pump thrombus may contribute to improvements in the safety of extracorporeal MCS.
Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences.
Tatsuki
T
Fujiwara
Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST).
Daisuke
D
Sakota
Department of Advanced Surgical Technology Research and Development, Tokyo Medical and Dental University.
Katsuhiro
K
Ohuchi
Center for Experimental Animals, Tokyo Medical and Dental University.
Shu
S
Endo
Faculty of Medicine, Tokyo Medical and Dental University.
Tomoki
T
Tahara
Graduate School of Science and Technology, Tokyo University of Science, Ibaraki, Japan.
Tomotaka
T
Murashige
Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST).
Ryo
R
Kosaka
Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences.
Keiji
K
Oi
Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences.
Tomohiro
T
Mizuno
Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST).
Osamu
O
Maruyama
Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences.
Hirokuni
H
Arai
D000818:Animals; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D061848:Optical Imaging / Q000295:instrumentation* / Q000379:methods; D013053:Spectrophotometry / Q000295:instrumentation / Q000379:methods; D013552:Swine; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology*
Centrifugal blood pump; Extracorporeal mechanical circulatory support; Extracorporeal membrane oxygenation; Hyperspectral imaging; Left ventricular assist device; Porcine model; Thrombus