Simulation of the effect of hemolysis on thrombosis in blood-contacting medical devices

IF 1.7 4区 医学 Q3 ENGINEERING, BIOMEDICAL
H. Valtchanov , R. Cecere , L.T.J. Atkinson , R. Mongrain
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引用次数: 0

Abstract

Heart failure, broadly characterized by the gradual decline of the ability of the heart to maintain adequate blood flow throughout the body's vascular network of veins and arteries, is one of the leading causes of death worldwide. Mechanical Circulatory Support is one of the few available alternative interventions for late-stage heart failure with reduced ejection fraction. A ventricular assist device is surgically implanted and connected to the left and or right heart ventricles to provide additional bloodflow, off-loading the work required by the heart to maintain circulation. Modern mechanical circulatory support devices generate non-physiological flow conditions that can lead to the damage and rupture of blood cells (hemolysis), and the formation of blood clots (thrombosis), which pose severe health risks to the patient. It is essential to improve prediction tools for blood damage to reduce the risk of hemolysis and thrombosis. A simulation-based approach examines the interaction between hemolysis and thrombosis. Incompressible finite-volume computational fluid dynamics simulations are executed on an open-hub axial flow ventricular assist device. A continuum model of thrombosis and the intrinsic coagulation process is extended to include the effect of hemolysis. The model accounts for the effect of activation of platelets by shear stress, paracrine signaling, adhesion, and hemoglobin and ADP released during hemolysis. The effect of hemolysis with thrombosis is modelled by accounting for the hyper-adhesivity of von-Willebrand Factor on extracellular hemoglobin, and the increased rate of platelet activation induced by ADP release. Thrombosis is assessed at varying inflow rates and rotor speeds, and cases are executed where thrombosis is affected by ADP release and Hb-induced hyper-adhesivity. It is found that there is a non-negligible effect from hemolysis on thrombosis across a range of rotor speeds, and that hyperadhesivity plays a dominant role in thrombus formation in the presence of hemolysis.

模拟溶血对血液接触医疗器械血栓形成的影响
心力衰竭的总体特征是心脏维持全身静脉和动脉血管网络充分血流的能力逐渐下降,是全球主要死亡原因之一。对于射血分数降低的晚期心衰,机械循环支持是为数不多的可供选择的干预措施之一。通过手术将心室辅助装置植入并连接到左心室或右心室,以提供额外的血流,减轻心脏维持血液循环所需的工作量。现代机械循环支持装置会产生非生理性血流条件,从而导致血细胞损伤和破裂(溶血),并形成血栓(血栓形成),对患者的健康造成严重威胁。必须改进血液损伤预测工具,以降低溶血和血栓形成的风险。一种基于模拟的方法对溶血和血栓形成之间的相互作用进行了研究。在开放式轴流心室辅助装置上执行了不可压缩有限体积计算流体动力学模拟。血栓形成和内在凝血过程的连续体模型被扩展到包括溶血的影响。该模型考虑了剪切应力、旁分泌信号、粘附以及溶血过程中释放的血红蛋白和 ADP 对血小板活化的影响。溶血对血栓形成的影响是通过考虑血管-威廉因子对细胞外血红蛋白的高粘附性以及 ADP 释放引起的血小板活化率增加来模拟的。在不同的流入率和转子速度下对血栓形成进行了评估,并对血栓形成受 ADP 释放和血红蛋白诱导的高粘附性影响的情况进行了分析。研究发现,在不同的转子速度下,溶血对血栓形成的影响都是不可忽略的,在溶血情况下,超粘附性对血栓形成起着主导作用。
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来源期刊
Medical Engineering & Physics
Medical Engineering & Physics 工程技术-工程:生物医学
CiteScore
4.30
自引率
4.50%
发文量
172
审稿时长
3.0 months
期刊介绍: Medical Engineering & Physics provides a forum for the publication of the latest developments in biomedical engineering, and reflects the essential multidisciplinary nature of the subject. The journal publishes in-depth critical reviews, scientific papers and technical notes. Our focus encompasses the application of the basic principles of physics and engineering to the development of medical devices and technology, with the ultimate aim of producing improvements in the quality of health care.Topics covered include biomechanics, biomaterials, mechanobiology, rehabilitation engineering, biomedical signal processing and medical device development. Medical Engineering & Physics aims to keep both engineers and clinicians abreast of the latest applications of technology to health care.
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