This study was designed to investigate the effects of hemodynamic environment and design factors on the hydraulic performance and hemocompatibility of interventional blood pumps using computational fluid dynamics methods combined with specialized mathematical models. These analyses assessed how different hemodynamic environments (such as support mode and artery size) and blood pump configurations (including entrance/exit blade angles, rotor diameter, blade number, and diffuser presence) affect hydraulic performance indicators (rotational speed, flow rate, pressure head, and efficiency) and hemocompatibility indicators (bleeding, hemolysis, and thrombosis). Our findings indicate that higher perfused flow rates necessitate greater rotational speeds, which, in turn, reduce both efficiency and hemocompatibility. As the artery size increases, the hydraulic performance of the pump improves but at the cost of worsening hemocompatibility. Among the design parameters, optimal configurations exist that balance both hydraulic performance and hemocompatibility. Notably, a configuration without a diffuser demonstrated better hydraulic performance and hemocompatibility compared to one with a diffuser. Further analysis revealed that flow losses primarily contribute to the degradation of hydraulic performance and deterioration of hemocompatibility. Shear stress was identified as the major cause of blood damage in interventional blood pumps, with residence time having a limited impact. This study comprehensively explored the effects of operating environment and design parameters on catheter pump performance using a multi-faceted blood damage model, providing insights into related complications from a biomechanical perspective. These findings offer valuable guidance for engineering design and clinical treatment.
REFERENCES
1.
A. I.
Papolos
et al, “
Impella management for the cardiac intensivist
,” ASAIO J.
68
(6
), 753
–758
(2022
).2.
E. V.
Potapov
et al, “
2019 EACTS Expert Consensus on long-term mechanical circulatory support
,” Eur. J. Cardiothorac. Surg.
56
(2
), 230
–270
(2019
).3.
S.
Saito
et al, “
Impella support as a bridge to heart surgery in patients with cardiogenic shock
,” Interact. Cardiovasc. Thorac. Surg.
35
(2
), ivac088
(2022
).4.
B.
Alushi
et al, “
Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock
,” Open Heart
6
(1
), e000987
(2019
).5.
L.
Succar
et al, “
Management of anticoagulation with Impella® percutaneous ventricular assist devices and review of new literature
,” J. Thromb. Thrombolysis
48
(2
), 284
–291
(2019
).6.
A. S. K.
Wong
and
S. W. C.
Sin
, “
Short-term mechanical circulatory support (intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation, TandemHeart): A review
,” Ann. Transl. Med.
8
(13
), 829
(2020
).7.
Abiomed
,
I.
,
Abiomed surpasses 50,000 Impella patients treated in the United States
, 2018
. https://www.dicardiology.com/content/abiomed-surpasses-50000-impella-patients-treated-united-states.8.
H. H.
Chera
et al, “
Overview of Impella and mechanical devices in cardiogenic shock
,” Expert Rev. Med. Dev.
15
(4
), 293
–299
(2018
).9.
J. J.
Glazier
and
A.
Kaki
, “
The Impella device: Historical background, clinical applications and future directions
,” Int. J. Angiol.
28
(2
), 118
–123
(2019
).10.
G. W.
Vetrovec
et al, “
The cVAD registry for percutaneous temporary hemodynamic support: A prospective registry of Impella mechanical circulatory support use in high-risk PCI, cardiogenic shock, and decompensated heart failure
,” Am. Heart J.
199
, 115
–121
(2018
).11.
N.
Roberts
et al, “
Hemolysis associated with Impella heart pump positioning: In vitro hemolysis testing and computational fluid dynamics modeling
,” Int. J. Artif. Organs
43
, 710
(2020
).12.
Y.
Li
et al, “
Multi-indicator analysis of mechanical blood damage with five clinical ventricular assist devices
,” Comput. Biol. Med.
151
(Pt A
), 106271
(2022
).13.
G. W.
Vetrovec
,
A.
Kaki
, and
T. G.
Dahle
, “
A review of bleeding risk with Impella-supported high-risk percutaneous coronary intervention
,” Heart Int.
14
(2
), 92
–99
(2020
).14.
M.
Oezkur
et al, “
Role of acquired von Willebrand syndrome in the development of bleeding complications in patients treated with Impella RP devices
,” Sci. Rep.
11
(1
), 23722
(2021
).15.
M.
Nakamura
et al, “
Pulmonary artery pulsatility index and hemolysis during Impella-incorporated mechanical circulatory support.
,” J. Clin. Med.
11
(5
), 1206
(2022
).16.
S.
Cardozo
,
T.
Ahmed
, and
K.
Belgrave
, “
Impella induced massive hemolysis: Reemphasizing echocardiographic guidance for correct placement.
,” Case Rep. Cardiol.
2015
, 464135
.17.
F.
Yamana
et al, “
Aortic thrombosis with visceral malperfusion during circulatory support with a combination of Impella and extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock
,” J. Artif. Organs
26
, 330
(2023
).18.
T.
Saito
et al, “
Left main trunk occlusion due to Impella-related thrombus in a patient with extracorporeal cardiopulmonary resuscitation
,” JACC Cardiovasc.
Interventions
14
(22
), e313
–e316
(2021
).19.
M.
Triep
et al, “
Computational fluid dynamics and digital particle image velocimetry study of the flow through an optimized micro-axial blood pump
,” Artif. Organs
30
(5
), 384
–391
(2006
).20.
Y.
Li
et al, “
The impact of rotor configurations on hemodynamic features, hemocompatibility and dynamic balance of the centrifugal blood pump: A numerical study
,” Int. J. Numer. Method Biomed. Eng.
39
, e3671
(2022
).21.
Y.
Li
et al, “
Impact of volute design features on hemodynamic performance and hemocompatibility of centrifugal blood pumps used in ECMO
,” Artif. Organs
47
(1
), 88
–104
(2023
).22.
W.
Peng
, “
Recent advances in the application of computational fluid dynamics in the development of rotary blood pumps
,” Med. Novel Technol. Devices
16
, 100117
(2022
).23.
Y.
Li
et al, “
Investigation of the influence of blade configuration on the hemodynamic performance and blood damage of the centrifugal blood pump
,” Artif. Organs
46
(9
), 1817
–1832
(2022
).24.
G.
Panuccio
et al, “
Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis
,” Int. J. Cardiol. Heart
Vasculature
40
, 101007
(2022
).25.
J. R.
Rock
et al, “
Single center first year experience and outcomes with Impella 5.5 left ventricular assist device
,” J. Cardiothorac. Surg.
17
(1
), 124
(2022
).26.
A.
Said
and
L.
Sayed
, “
Percutaneous thrombectomy of Impella-associated iliac artery thrombosis using the FlowTriever system
,” Clin. Case Rep.
8
(12
), 2645
–2649
(2020
).27.
K. H.
Fraser
et al, “
A quantitative comparison of mechanical blood damage parameters in rotary ventricular assist devices: Shear stress, exposure time and hemolysis index
,” J. Biomech. Eng.
134
(8
), 081002
(2012
).28.
B.
Thamsen
et al, “
Numerical analysis of blood damage potential of the HeartMate II and HeartWare HVAD rotary blood pumps
,” Artif. Organs
39
(8
), 651
–659
(2015
).29.
L.
Ge
et al, “
Characterization of hemodynamic forces induced by mechanical heart valves: Reynolds vs. viscous stresses
,” Ann. Biomed. Eng.
36
(2
), 276
–297
(2008
).30.
G.
Radley
et al, “
In vitro benchmarking study of ventricular assist devices in current clinical use
,” J. Card. Failure
26
(1
), 70
–79
(2020
).31.
Z.
Chen
et al, “
Flow features and device-induced blood trauma in CF-VADs under a pulsatile blood flow condition: A CFD comparative study
,” Int. J. Numer. Method Biomed. Eng.
34
(2
), e2924
(2018
).32.
C.
Menichini
and
X. Y.
Xu
, “
Mathematical modeling of thrombus formation in idealized models of aortic dissection: Initial findings and potential applications
,” J. Math. Biol.
73
(5
), 1205
–1226
(2016
).33.
Y.
Li
et al, “
A mathematical model for assessing shear induced bleeding risk
,” Comput. Methods Programs Biomed.
231
, 107390
(2023
).34.
Y.
Li
et al, “
Multi-method investigation of blood damage induced by blood pumps in different clinical support modes
,” ASAIO J.
70
(4
), 280
–292
(2024
).35.
J.
Ding
et al, “
Quantification of shear-induced platelet activation: High shear stresses for short exposure time
,” Artif. Organs
39
(7
), 576
–583
(2015
).36.
Z.
Chen
et al, “
Quantitative characterization of shear-induced platelet receptor shedding: Glycoprotein Ibalpha, glycoprotein VI, and glycoprotein IIb/IIIa
,” ASAIO J.
64
(6
), 773
–778
(2018
).37.
W. T.
Wu
et al, “
Simulation of thrombosis in a stenotic microchannel: The effects of vWF-enhanced shear activation of platelets
,” Int. J. Eng. Sci.
147
, 103206
(2020
).38.
M. E.
Taskin
et al, “
Evaluation of Eulerian and Lagrangian models for hemolysis estimation
,” ASAIO J.
58
(4
), 363
–372
(2012
).39.
R.
Baljepally
and
H.
Tahir
, “
Effect of atrioventricular dyssynchrony on Impella hemodynamics: Mechanism and its clinical implications
,” Cardiol. Res.
12
(4
), 219
–224
(2021
).40.
F.
Burzotta
et al, “
Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group
,” Int. J. Cardiol.
201
, 684
–691
(2015
).41.
S. K.
Annamalai
et al, “
Abdominal positioning of the next-generation intra-aortic fluid entrainment pump (Aortix) improves cardiac output in a swine model of heart failure
,” Circ. Heart Fail.
11
(8
), e005115
(2018
).42.
A. N.
Vora
et al, “
First-in-human experience with Aortix intraaortic pump
,” Catheterization Cardiovasc.
Interventions
93
(3
), 428
–433
(2019
).43.
P. L.
Hsu
et al, “
An extended computational model of the circulatory system for designing ventricular assist devices
,” ASAIO J.
54
(6
), 594
–599
(2008
).44.
D. M.
Ouweneel
et al, “
Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction
,” J. Am. Coll. Cardiol.
69
(3
), 278
–287
(2017
).45.
S.
Ranc
,
F.
Sibellas
, and
L.
Green
, “
Acute intraventricular thrombosis of an Impella LP 5.0 device in an ST-elevated myocardial infarction complicated by cardiogenic shock
,” J. Invasive Cardiol.
25
(1
), E1
–E3
(2013
).46.
Y.
Nakao
et al, “
Usefulness of contrast computed tomography for diagnosing left ventricular thrombus before Impella insertion
,” J. Cardiol. Cases
22
(6
), 291
–293
(2020
).47.
E.
Wood
,
C.
Hayes
, and
A.
Hart
, “
Anticoagulation management for Impella percutaneous ventricular assist devices: An analysis of a single-center experience
,” Ann. Pharmacother.
54
(11
), 1073
–1082
(2020
).48.
I.
Salas de Armas
et al, “
Surgically implanted Impella device for patients on Impella CP support experiencing refractory hemolysis
,” ASAIO J.
68
(12
), e251
–e255
(2022
).© 2024 Author(s). Published under an exclusive license by AIP Publishing.
2024
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