The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD

Abstract

Heart failure remains a significant cause of mortality in the United States and around the world. While organ transplantation is acknowledged as the gold standard treatment for end stage heart failure, supply is limited, and many patients are treated with left ventricular assist devices (LVADs). LVADs extend and improve patients' lives, but they are not without their own complications, particularly the hemocompatibility related adverse events (HRAE) including stroke, bleeding and pump thrombosis. Mainstream imaging techniques currently in use to assess appropriate device function and troubleshoot complications, such as echocardiography and cardiac computed tomography, provide some insight but do not provide a holistic understanding of pump induced flow alterations that leads to HRAEs. In contrast, there are technologies restricted to the benchtop—such as computational fluid dynamics and mock circulatory loops paired with methods like particle image velocimetry—that can assess flow metrics but have not been optimized for clinical care. In this review, we outline the potential role and current limitations of converging available technologies to produce novel imaging techniques, and the potential utility in evaluating hemodynamic flow to determine whether LVAD patients may be at higher risk of HRAEs. This addition to diagnostic and monitoring capabilities could improve prevention and treatment of LVAD-induced complications in heart failure patients.

Computational investigation of outflow graft variation impact on hemocompatibility profile in LVADs

“…In our single‐center study for a predominantly HeartMate II population, we were able to demonstrate a correlation of outflow cannula orientation relative to the aorta (angulation at the site of anastomosis) with stroke 7 . The motivation for the current study was to understand this relationship better by studying fluid metrics that are otherwise not visualized with conventional imaging techniques 8 …”

“…7 The motivation for the current study was to understand this relationship better by studying fluid metrics that are otherwise not visualized with conventional imaging techniques. 8 Cardiac computed tomography paired with computational modeling and simulation provides an effective means to evaluate the altered flow conditions induced by LVADs and may incorporate patient-specific imaging data for this purpose. Previous computational studies have investigated hemodynamics in LVAD patients with respect to changes in outflow graft orientation.…”