The Lavare cycle effectively generates ventricular washout and the adverse event profiles of ReVOLVE patients with the Lavare cycle on were better than those with the Lavare cycle off. Larger studies are warranted to verify the positive effect of the Lavare cycle and to optimize speed modulation settings, so additional clinically relevant improvements can be realized.

The use of left ventricular assist devices (LVADs) as a treatment method for heart failure patients has been steadily increasing; however, pathological studies showed presence of thrombi around the HeartWare ventricular assist device inflow cannula (IC) in more than 95% of patients after device explantation. Flow fields around the IC might trigger thrombus formation and require further investigation. In this study flow dynamics parameters were evaluated for different patient geometries using computational fluid dynamics (CFD) simulations. Left ventricular (LV) models of two LVAD patients were obtained from CT scans. The LV volumes of Patient 1 (P1) and Patient 2 (P2) were 264 and 114 cm 3 with an IC angle of 20° and 9° from the mitral‐IC tip axis at the coronal plane. The IC insertion site at the apex was central for P1, whereas it was lateral for P2. Transient CFD simulations were performed over 9 cardiac cycles. The wedge area was defined from the cannula tip to the wall of the LV apex. Mean velocity magnitude and blood stagnation region (volume with mean velocity <5 mm/s) as well as the wall shear stress (WSS) at the IC surface were calculated. Cardiac support resulted in a flow mainly crossing the ventricle from the mitral valve to the LVAD cannula for P2, while the main inflow jet deviated toward the septal wall in P1. Lower WSS at the IC surface and consequently larger stagnation volumes were observed for P2 (P1: 0.17, P2: 0.77 cm 3 ). Flow fields around an LVAD cannula can be influenced by many parameters such as LV size, IC angle, and implantation site. Careful consideration of influencing parameters is essential to get reliable evaluations of the apical flow field and its connection to apical thrombus formation. Higher blood washout and lower stagnation were observed for a central implantation of the IC at the apex.

An isolated heart setup including an RBP was developed, which combines the advantages of in silico/vitro methods and animal experiments. This tool thus provides further insight into the interaction between the heart and an RBP.

Associate Editor Jane Grande-Allen oversaw the review of this article.

Malpositioning of left ventricular assist devices (LVAD) is a risk factor for thrombosis, but its identification from clinical imaging remains challenging. X-rays and CT scans were analyzed and parameters identified that correlated to pump thrombosis. Retrospective imaging data of patients ( n = 115) with HeartmateII (HMII) or HVAD were analyzed in two groups (pump-thrombosis PT, n = 15 vs matched control group NT, n = 15) using routine X-rays and CT scans. In CT, directional deviations of the inflow cannula in three-chamber and two-chamber view (α and β angles) were identified. In HVAD PT frontal radiographs showed reduced pump body area and smaller minor axis (PT 41.3 ± 4.8 mm vs NT 34.9 ± 6.0 mm, p = 0.026), and in the lateral radiographs the visibility of the inflow cannula served as a predictive parameter for PT. In HMII patients, no parameters were associated with PT. The angle α differed significantly (NT −1.2 ± 7.5°, PT −22.0 ± 4.7°, p = 0.006) in HVAD patients. Further, correlations of x-ray parameters with CT angles α and β showed that radiographs can be used to identify malpositioned pumps. Well-aligned inflow cannula positions are essential. HVAD patients with a posterior rotation of the inflow cannula have a higher risk of pump thrombosis. This risk can reliably be identified from routine radiographs.

Left ventricular assist devices inherently alter the intraventricular flow field and create areas of blood stasis with potential thrombus formation. The Lavare cycle of the Medtronic Heart-Ware HVAD was designed to improve ventricular washout. This study aims to evaluate its effects on ventricular washout in a pulsatile in vitro setting with a focus on the timing of pump speed changes. Ventricular flow fields were obtained via particle image velocimetry in two modes: With constant left ventricular assist devices speed and with the Lavare cycle applied. The start of the Lavare cycle was shifted over an entire cardiac cycle, and ventricular washout was evaluated based on velocity fields, kinetic energy, and normalized pulsatility of flow fields. The ventricular flow fields showed dependence on the timing of the Lavare cycle and interaction between speed changes and the cardiac phase. Higher apical velocity was observed for speed decreases at the late E wave and for increases at mid systole by 29% (P = 0.002) and 61% (P < 0.001), respectively. Mean apical kinetic energy for these phases also increased by 21% (P = 0.0013) and 46% (P < 0.001). The Lavare cycle generally promotes higher apical washout and can specifically generate further improved washout if speed steps are applied at the correct timing on the cardiac cycle.

In heart failure therapy, minimally invasive devices (transcatheter valves, catheter‐based cannulas or pumps) are increasingly used. The interaction with the valve is of special importance as valve damage, backflow, and thrombus formation are known complications. Therefore, the aim of this in vitro study was to characterize the forces acting on different sized transvalvular cannulas at various transvalvular pressures for four different valves. In a pulsatile setup radial and tangential forces on transvalvular cannulas were measured for bioprosthetic, artificial pericardial tissue, fresh, and fixated porcine valves. The cannula position was varied from a central position to the wall in 10° rotational steps for the whole circular range and the use of different cannula diameters (4, 6, and 8 mm) and transvalvular pressures (40‐100 mmHg). Centering forces of four different aortic valve types were identified and the three leaflets were visible in the force distribution. At the mid of the cusps and at the largest deflection the forces were highest (up to 0.8 N) and lowest in the commissures (up to 0.2 N). Whereas a minor influence of the cannula diameter was found, the transvalvular pressure linearly increased the forces but did not alter the force patterns. Centering forces that act on transvalvular cannulas were identified in an in vitro setup for several valves and valve types. Lowest centering forces were found in the commissures and highest forces were found directly at the cusps. At low pressures, low centering forces and an increased cannula movement can be expected.

Intraventricular flow patterns during left ventricular assist device support have been investigated via computational fluid dynamics by several groups. Based on such simulations, specific parameters for thrombus formation risk analysis have been developed. However, computational fluid dynamic simulations of complex flow configurations require proper validation by experiments. To meet this need, a ventricular model with a well-defined inflow section was analyzed by particle image velocimetry and replicated by transient computational fluid dynamic simulations. To cover the laminar, transitional, and turbulent flow regime, four numerical methods including the laminar, standard k-omega, shear-stress transport, and renormalized group k-epsilon were applied and compared to the particle image velocimetry results in 46 different planes in the whole left ventricle. The simulated flow patterns for all methods, except renormalized group k-epsilon, were comparable to the flow patterns measured using particle image velocimetry (absolute error over whole left ventricle: laminar: 10.5, standard k-omega: 11.3, shear–stress transport: 11.3, and renormalized group k-epsilon: 17.8 mm/s). Intraventricular flow fields were simulated using four numerical methods and validated with experimental particle image velocimetry results. In the given setting and for the chosen boundary conditions, the laminar, standard K-omega, and shear–stress transport methods showed acceptable similarity to experimental particle image velocimetry data, with the laminar model showing the best transient behavior.