论文标题
LVAD入口套管连接的血栓形成的多尺度模拟：Virchow Triad的重要性
Multi-scale simulation of thrombus formation at LVAD inlet cannula connection: Importance of Virchow's triad
论文作者
论文摘要
由于电流产生的心室辅助装置（VAD）降低泵血栓形成，因此出血或中风等不良事件仍以无法接受的速度保持不良。 VAD入口套管（IC）周围的血栓形成已被强调为中风事件的可能来源。最近的计算流体动力学（CFD）研究试图表征不同IC-易位构型的血栓形成风险。但是，纯粹的CFD模拟将血栓形成风险与基于流量特征的临时标准有关，而对生化因素几乎没有考虑。这项研究研究了IC血栓形成的起源，包括Virchow三合会的两个元素：内皮损伤和高凝性。为此，进行了包括血小板活性和凝结反应的多尺度血栓形成模拟。我们的结果表明，靠近IC壁的停滞区域（| U | <0.002 m/s）的凝血酶形成显着。此外，在套管的前沿尖端上观察到高剪切介导的血小板激活，这反映了临床上观察到的血栓沉积模式。当前的研究揭示了生化因素对心室结局在血栓形成的起源的重要性，该结构可以从抗凝/抗血小板治疗方面为临床决策提供信息，并指导工程师开发更强大的设计。
As pump thrombosis is reduced in current-generation ventricular assist devices (VAD), adverse events such as bleeding or stroke remain at unacceptable rates. Thrombosis around the VAD inlet cannula (IC) has been highlighted as a possible source of stroke events. Recent computational fluid dynamics (CFD) studies have attempted to characterize the thrombosis risk of different IC-ventricle configurations. However, purely CFD simulations relate thrombosis risk to ad-hoc criteria based on flow characteristics, with little consideration of biochemical factors. This study investigates the genesis of IC thrombosis including two elements of the Virchow's triad: Endothelial injury and Hypercoagulability. To this end a multi-scale thrombosis simulation that includes platelet activity and coagulation reactions was performed. Our results show significant thrombin formation in stagnation regions (|u|< 0.002 m/s) close to the IC wall. In addition, high shear-mediated platelet activation was observed over the leading-edge tip of the cannula which mirrors the thrombus deposition pattern observed clinically. The current study reveals the importance of biochemical factors to the genesis of thrombosis at the ventricular-cannula junction which can inform clinical decisions in terms of anticoagulation/antiplatelet therapy and guide engineers to develop more robust designs.
