Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
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Date
2022-03-11
Publication Type
Journal Article
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yes
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Abstract
While earlier studies reported no relevant effect of the HeartMate 3 (HM3) artificial pulse
(AP) on bulk pump washout, its effect on regions with prolonged residence times remains
unexplored. Using numerical simulations, we compared pump washout in the HM3 with
and without AP with a focus on the clearance of the last 5% of the pump volume. Results
were examined in terms of flush-volume (Vf , number of times the pump was flushed with
new blood) to probe the effect of the AP independent of changing flow rate. Irrespective of
the flow condition, the HM3 washout scaled linearly with flush volume up to 70%washout
and slowed down for the last 30%. Flush volumes needed to washout 95% of the pump
were comparable with and without the AP (1.3–1.4 Vf ), while 99% washout required
2.1–2.2 Vf with the AP vs. 2.5 Vf without the AP. The AP enhanced washout of the bend
relief and near-wall regions. It also transiently shifted or eliminated stagnation regions and
led to rapid wall shear stress fluctuations below the rotor and in the secondary flow path.
Our results suggest potential benefits of the AP for clearance of fluid regions that might
elicit in-pump thrombosis and provide possible mechanistic rationale behind clinical data
showing very low rate of in-pump thrombosis with the HM3. Further optimization of the
AP sequence is warranted to balance washout efficacy while limiting blood damage.
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published
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Journal / series
Volume
9
Pages / Article No.
775780
Publisher
Frontiers Media
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Edition / version
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Date collected
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Subject
Left ventricular assist device (LVAD); computational fluid dynamics (CFD); HeartMate 3 (HM3); pump thrombosis; Washout; rotational speed modulation; wall shear stress (WSS)
Organisational unit
03943 - Meboldt, Mirko / Meboldt, Mirko