Effect of Outflow Graft Size on Flow in the Aortic Arch and Cerebral Blood Flow in Continuous Flow Pumps: Possible Relevance to Strokes
| Autor: | Komrakshi R. Balakrishnan, Sindhoor Bhat, Ramarathnam Krishna Kumar, Jayakala Mathew |
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| Rok vydání: | 2017 |
| Předmět: |
Aortic arch
medicine.medical_specialty medicine.medical_treatment Aortic Valve Insufficiency 0206 medical engineering Biomedical Engineering Biophysics Pulsatile flow Aorta Thoracic Bioengineering 02 engineering and technology 030204 cardiovascular system & hematology Anastomosis Biomaterials 03 medical and health sciences 0302 clinical medicine medicine.artery Internal medicine medicine Humans Stroke Aorta business.industry General Medicine medicine.disease 020601 biomedical engineering Surgery medicine.anatomical_structure Cerebral blood flow Cerebrovascular Circulation Pulsatile Flow Ventricular assist device Cardiology Heart-Assist Devices business Artery |
| Zdroj: | ASAIO Journal. 63:144-149 |
| ISSN: | 1058-2916 |
| DOI: | 10.1097/mat.0000000000000507 |
| Popis: | One of the most devastating complications of continuous flow left ventricular devices (CFLVADS) is stroke, with a higher incidence in HeartWare Ventricular Assist Device (HVAD) as compared with HEARTMATE II. The reason for the observed difference in stroke rates is unclear. Because outflow graft diameters are different, we hypothesized that this could contribute to the difference in stroke rates. A computational fluid-structure interaction model was created from the computed tomography (CT) scan of a patient. Pressures were used as the boundary condition and the flow through the cerebral vessels was derived as outputs. Flow into the innominate artery was very sensitive to the anastomosis angle for a 10 mm as compared with a 14 mm graft, with the net innominate flow severely compromised with a 10 mm graft at 45° angle. Aortic insufficiency seems to affect cerebral blood flow nonlinearly with an 80% decrease at certain angles of outflow graft anastomosis. Arterial return in to the arch through a narrow graft has important jet effects and results in significant flow perturbations in the aortic arch and cerebral vessels and stasis. A 10 mm graft is more sensitive to angle of insertion than a 14 mm graft. Under some conditions, serious hypoperfusion of the innominate artery is possible. Aortic incompetence results in significant decrease of cerebral blood flow. No stasis was found in the pulsatile flow compared with LVAD flow. |
| Databáze: | OpenAIRE |
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