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Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?

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 cle...

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Autores principales: Fang, Peng, Du, Jianjun, Boraschi, Andrea, Bozzi, Silvia, Redaelli, Alberto, Schmid Daners, Marianne, Kurtcuoglu, Vartan, Consolo, Filippo, de Zélicourt, Diane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962620/
https://www.ncbi.nlm.nih.gov/pubmed/35360020
http://dx.doi.org/10.3389/fcvm.2022.775780
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author Fang, Peng
Du, Jianjun
Boraschi, Andrea
Bozzi, Silvia
Redaelli, Alberto
Schmid Daners, Marianne
Kurtcuoglu, Vartan
Consolo, Filippo
de Zélicourt, Diane
author_facet Fang, Peng
Du, Jianjun
Boraschi, Andrea
Bozzi, Silvia
Redaelli, Alberto
Schmid Daners, Marianne
Kurtcuoglu, Vartan
Consolo, Filippo
de Zélicourt, Diane
author_sort Fang, Peng
collection PubMed
description 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 (V(f), 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 V(f)), while 99% washout required 2.1–2.2 V(f) with the AP vs. 2.5 V(f) 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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spelling pubmed-89626202022-03-30 Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout? Fang, Peng Du, Jianjun Boraschi, Andrea Bozzi, Silvia Redaelli, Alberto Schmid Daners, Marianne Kurtcuoglu, Vartan Consolo, Filippo de Zélicourt, Diane Front Cardiovasc Med Cardiovascular Medicine 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 (V(f), 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 V(f)), while 99% washout required 2.1–2.2 V(f) with the AP vs. 2.5 V(f) 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. Frontiers Media S.A. 2022-03-11 /pmc/articles/PMC8962620/ /pubmed/35360020 http://dx.doi.org/10.3389/fcvm.2022.775780 Text en Copyright © 2022 Fang, Du, Boraschi, Bozzi, Redaelli, Schmid Daners, Kurtcuoglu, Consolo and de Zélicourt. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Fang, Peng
Du, Jianjun
Boraschi, Andrea
Bozzi, Silvia
Redaelli, Alberto
Schmid Daners, Marianne
Kurtcuoglu, Vartan
Consolo, Filippo
de Zélicourt, Diane
Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
title Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
title_full Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
title_fullStr Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
title_full_unstemmed Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
title_short Insights Into the Low Rate of In-Pump Thrombosis With the HeartMate 3: Does the Artificial Pulse Improve Washout?
title_sort insights into the low rate of in-pump thrombosis with the heartmate 3: does the artificial pulse improve washout?
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962620/
https://www.ncbi.nlm.nih.gov/pubmed/35360020
http://dx.doi.org/10.3389/fcvm.2022.775780
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