From the Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania.
Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
ASAIO J. 2023 Dec 1;69(12):1065-1073. doi: 10.1097/MAT.0000000000002028. Epub 2023 Aug 7.
Congenital heart disease affects approximately 40,000 infants annually in the United States with 25% requiring invasive treatment. Due to limited number of donor hearts and treatment options available for children, pediatric ventricular assist devices (PVADs) are used as a bridge to transplant. The 12cc pneumatic Penn State PVAD is optimized to prevent platelet adhesion and thrombus formation at patient nominal conditions; however, children demonstrate variable blood hematocrit and elevated heart rates. Therefore, with pediatric patients exhibiting greater variability, particle image velocimetry is used to evaluate the PVAD with three non-Newtonian hematocrit blood analogs (20%, 40%, and 60%) and at two beat rates (75 and 120 bpm) to understand the device's performance. The flow fields demonstrate a strong inlet jet that transitions to a solid body rotation during diastole. During systole, the rotation dissipates and reorganizes into an outlet jet. This flow field is consistent across all hematocrits and beat rates but at a higher velocity magnitude during 120 bpm. There are also minor differences in flow field timing and surface washing due to hematocrit. Therefore, despite patient differences in hematocrit or required pumping output, thorough surface washing can be achieved in the PVAD by altering operating conditions, thus reducing platelet adhesion potential.
先天性心脏病每年影响美国约 4 万名婴儿,其中 25%需要侵入性治疗。由于供体心脏数量有限,且可供儿童使用的治疗选择有限,儿科心室辅助装置 (PVAD) 可用作移植的桥梁。优化后的 12cc 气动宾夕法尼亚州立大学 PVAD 可在患者标称条件下防止血小板黏附和血栓形成;然而,儿童的血液红细胞压积和心率会发生变化。因此,对于儿科患者的变异性更大,采用粒子图像测速法 (PIV) 用三种非牛顿红细胞比容血液模拟物(20%、40%和 60%)和两种搏动率(75 和 120 bpm)来评估 PVAD,以了解设备的性能。流场显示出强烈的入口射流,在舒张期转变为固体旋转。在收缩期,旋转消散并重新组织成出口射流。该流场在所有红细胞比容和搏动率下都是一致的,但在 120 bpm 时速度更高。由于红细胞比容的原因,流场的定时和表面冲洗也存在微小差异。因此,尽管患者的红细胞比容或所需的泵送输出存在差异,但通过改变操作条件,可以在 PVAD 中实现彻底的表面冲洗,从而降低血小板黏附的可能性。