Francesco Scardulla1, Salvatore Pasta2, Leonardo D'Acquisto1, Sergio Sciacca3, Valentina Agnese3, Christian Vergara4, Alfio Quarteroni5, Francesco Clemenza3, Diego Bellavia3, Michele Pilato3. 1. Dipartimento dell׳Innovazione Industriale e Digitale, Università di Palermo, Palermo, Italy. 2. Fondazione Ri.MED, Palermo, Italy; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, (IRCCS-ISMETT), Palermo, Italy. Electronic address: spasta@fondazionerimed.com. 3. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, (IRCCS-ISMETT), Palermo, Italy. 4. Laboratorio di Modellistica e Calcolo Scientifico (MOX), Dipartimento di Matematica, Politecnico di Milano, Milan, Italy. 5. Laboratorio di Modellistica e Calcolo Scientifico (MOX), Dipartimento di Matematica, Politecnico di Milano, Milan, Italy; Mathematics in Computational Science and Engineering (SB MATHICSE CMCS), École polytechnique fédérale de Lausanne, Lausanne, Switzerland.
Abstract
BACKGROUND: The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. METHODS: Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. RESULTS: Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 ± 5.45 Pa, with an average flow velocity of 0.57 ± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 ± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk (R = 0.9), which may increase vulnerability of this vessel to bleeding. CONCLUSIONS: Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients.
BACKGROUND: The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. METHODS: Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. RESULTS: Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 ± 5.45 Pa, with an average flow velocity of 0.57 ± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 ± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk (R = 0.9), which may increase vulnerability of this vessel to bleeding. CONCLUSIONS: Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients.
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