HeartWare 心室辅助装置在儿科患者中的血液创伤潜力。
Blood trauma potential of the HeartWare Ventricular Assist Device in pediatric patients.
机构信息
Department of Surgery, Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Department of Surgery, Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
出版信息
J Thorac Cardiovasc Surg. 2020 Apr;159(4):1519-1527.e1. doi: 10.1016/j.jtcvs.2019.06.084. Epub 2019 Jul 19.
OBJECTIVE
Mechanical circulatory support has become a standard therapy for adult patients with end-stage heart failure. For pediatric patients, technologic development lags behind with no currently approved implantable rotary blood pump. As an alternative, the HeartWare Ventricular Assist Device (Medtronic, Minneapolis, Minn), originally designed for adults, is increasingly used in pediatric patients. The aim of this multicenter study was to assess in silico, in vitro, and in vivo the blood trauma potential of this pump in pediatric application.
METHODS
Clinical outcome and indicators for in vivo blood trauma were investigated retrospectively in 14 pediatric patients with the HeartWare Ventricular Assist Device (age 11.3 ± 4.8 years). Blood trauma mechanisms of the HeartWare Ventricular Assist Device were examined in silico and in vitro at an adult and pediatric operating point (5 L/min and 2.5 L/min at 2800 rpm and 2200 rpm, respectively). The flow was simulated by computational fluid dynamics and analyzed regarding flow structures, shear stresses, and washout. Hemolysis was assessed with pumps circulating bovine blood in a temperate flow circuit.
RESULTS
In the retrospective in vivo analysis, lactate dehydrogenase and D-dimer values were 1.5- and 3-fold elevated, respectively, compared with adult patients with the HeartWare Ventricular Assist Device. Major bleedings were observed in 42.9%, and suspected pump thrombosis and neurologic dysfunction were observed in 14.3% of all patients. In the pediatric conditions, simulations predicted elevated mechanical stress profile below 50 Pa, more stagnant flow field, and longer washout times within the pump. In vitro measurements revealed an increased normalized index of hemolysis (17.5 vs 8.2 mg/100 L; P = .0021).
CONCLUSIONS
The HeartWare Ventricular Assist Device, operated at lower speeds and flows, induces elevated blood trauma. Further studies are required to assess the clinical implications of these findings.
目的
机械循环支持已成为治疗终末期心力衰竭成人患者的标准疗法。对于儿科患者，技术发展滞后，目前尚无批准的植入式旋转血泵。作为替代方案，最初为成人设计的 HeartWare 心室辅助装置（美敦力公司，明尼苏达州明尼阿波利斯）越来越多地用于儿科患者。本多中心研究的目的是评估该泵在儿科应用中的体内、体外和体内血液创伤潜力。
方法
回顾性调查了 14 例使用 HeartWare 心室辅助装置（年龄 11.3±4.8 岁）的儿科患者的临床结果和体内血液创伤指标。在成人和儿科工作点（分别为 2800rpm 和 2200rpm 时 5L/min 和 2.5L/min）下，通过计算流体动力学进行体内和体外血液创伤机制的研究。通过计算流体动力学模拟流动，并分析流动结构、剪切应力和冲洗情况。使用循环牛血的泵在温和流动回路中评估溶血。
结果
在回顾性体内分析中，与使用 HeartWare 心室辅助装置的成年患者相比，乳酸脱氢酶和 D-二聚体值分别升高了 1.5 倍和 3 倍。42.9%的患者发生重大出血，14.3%的患者疑似发生泵血栓形成和神经功能障碍。在儿科条件下，模拟预测泵内机械应力谱低于 50Pa，血流场更停滞，冲洗时间更长。体外测量显示归一化溶血指数增加（17.5 比 8.2mg/100L；P=0.0021）。
结论
以较低的速度和流量运行的 HeartWare 心室辅助装置会引起更高的血液创伤。需要进一步研究来评估这些发现的临床意义。
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