Abstract

A Left Ventricular Assist Device (LVAD), is a mechanical pump capable of providing circulatory myocardium relief when used as bridge-to-transplantation by reducing the workload of a failing heart, with the additional bonus of allowing for cardiac recovery when used as destination therapy. The newer generations of continuous flow VADs are essentially axial or radial flow pumps, and while these devices are capable their efficiency depends upon fluid composition and flow field patterns. The most devastating complication of VAD therapy is caused by embolization of thrombi formed within the LVAD or inside the heart into the brain leading to stroke. Anticoagulation management and improved LVADs design has reduced stroke incidence, however, investigators have recently reported the incidence of thromboembolic cerebral events is still significant and ranges from 14% to 47% over a period of 6-12 months. Blood clots may cause obstruction of critical vessels, such as cerebral arteries, reducing brain oxygenation and resulting in devastating consequences like major neurocognitive malfunction and complications which can be fatal. The hypothesis that incidence of stroke can be significantly reduced by adjusting the VAD outflow cannula implantation to direct dislodged thrombi away from the cerebral vessels has been recently supported by a series of steady flow computations assuming rigid vessel walls for the vasculature. Such studies have shown as much as a 50% reduction in embolization rates depending on outflow cannula implantation. In this study, a pulsatile fully compliant vessel wall model is developed to further establish this hypothesis. A time-dependent multi-scale Eulerian Computational Fluid Dynamics (CFD) analysis of patient-specific geometry models of the VAD-bed vasculature is coupled with a 3D Finite Element Analysis (FEA) of the mechanical response of the vascular walls to establish the VAD assisted hemodynamics. A Lagrangian particle tracking algorithm is used to determine the embolization rates of thrombi emanating from the cannula or other possible thrombogenic locations such as the aortic root. This multiscale Eulerian-Lagrangian pulsatile fluid-structure coupled paradigm allows for a fully realistic model of the hemodynamics of interest. The patient-specific geometries obtained from CT scan are implemented into the numerical domain in two modes. In the 3D CFD portion of the problem, the geometry accounts solely for the flow volume where the fluid is modelled as constant density and non-Newtonian under laminar pulsatile flow conditions. The blood-thrombus ensemble in treated as a two-phase flow, handled by an Eulerian-Lagrangian coupled scheme to solve the flow field and track particle transport. Thrombi are modelled as constant density spherical particles. Particle interactions are limited to particle-to-wall and particle-to-fluid, while particle-to-particle interaction are neglected for statistical purposes. On the other hand, with the help of Computer Aided Design (CAD) software a patient-specific aortic wall geometry with variable wall thickness is brought into the numerical domain. FEA is applied to determine the aortic wall cyclic displacement under hydrodynamic loads. To properly account for wall deformation, the arterial wall tissue incorporates a hyperelastic material model based on the anisotropic Holzapfel model for arteries. This paradigm is referred to as Fluid Structure Interaction (FSI) and allows structural analysis in conjunction with flow investigation to further monitor pathological flow patterns. The FSI model is driven by time dependent flow and pressure boundary conditions imposed at the boundaries of the 3D computational domain through a 50 degree of freedom 0D lumped parameter model (LPM) electric circuit analog of the peripheral VAD-assisted circulation. Results are presented for a simple vessel model of the ascending aorta to validate the anisotropic fiber orientation implementation. Arterial wall dilation is measured between 5-20% in the range reported in literature. Hemodynamics of the VAD assisted flow in a patient-derived geometry computed using rigid vessels walls are compared to those for a linearly elastic vessel wall model and a hyperelastic anisotropic vessel wall model. Moreover, the thromboembolization rates are presented and compared for pulsatile hemodynamics in rigid and compliant wall models. Pulsatile flow solutions for embolization probabilities corroborate the hypothesis that tailoring the LVAD cannula implantation configuration can significantly reduce thromboembolization rates, and this is consistent with indications from previous steady-flow calculations.

Notes

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Graduation Date

2018

Semester

Spring

Advisor

Kassab, Alain

Degree

Doctor of Philosophy (Ph.D.)

College

College of Engineering and Computer Science

Department

Mechanical and Aerospace Engineering

Degree Program

Mechanical Engineering

Format

application/pdf

Identifier

CFE0007077

URL

http://purl.fcla.edu/fcla/etd/CFE0007077

Language

English

Release Date

May 2018

Length of Campus-only Access

None

Access Status

Doctoral Dissertation (Open Access)

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