The Impact of Left Ventricular Assist Device Outflow Graft Positioning on Aortic Hemodynamics: Improving Flow Dynamics to Mitigate Aortic Insufficiency

Author:

Gu Zhuohan1ORCID,Ong Chi Wei2ORCID,Mi Yongzhen3ORCID,Seetharaman Ashwin1ORCID,Ling Ryan Ruiyang4ORCID,Ramanathan Kollengode45ORCID,Leo Hwa Liang1

Affiliation:

1. Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore

2. School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore

3. Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore 138632, Singapore

4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore

5. Cardiothoracic Intensive Care Unit, National University Heart Centre Singapore, National Univeristy Health System, Singapore 119228, Singapore

Abstract

Heart failure is a global health concern with significant implications for healthcare systems. Left ventricular assist devices (LVADs) provide mechanical support for patients with severe heart failure. However, the placement of the LVAD outflow graft within the aorta has substantial implications for hemodynamics and can lead to aortic insufficiency during long-term support. This study employs computational fluid dynamics (CFD) simulations to investigate the impact of different LVAD outflow graft locations on aortic hemodynamics. The introduction of valve morphology within the aorta geometry allows for a more detailed analysis of hemodynamics at the aortic root. The results demonstrate that the formation of vortex rings and subsequent vortices during the high-velocity jet flow from the graft interacted with the aortic wall. Time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) indicate that modification of the outflow graft location changes mechanical states within the aortic wall and aortic valve. Among the studied geometric factors, both the height and inclination angle of the LVAD outflow graft are important in controlling retrograde flow to the aortic root, while the azimuthal angle primarily determines the rotational direction of blood flow in the aortic arch. Thus, precise positioning of the LVAD outflow graft emerges as a critical factor in optimizing patient outcomes by improving the hemodynamic environment.

Funder

Singapore Biodesign Early Prototyping Fund

Publisher

MDPI AG

Subject

Molecular Medicine,Biomedical Engineering,Biochemistry,Biomaterials,Bioengineering,Biotechnology

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