From the Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
ASAIO J. 2024 Apr 1;70(4):280-292. doi: 10.1097/MAT.0000000000002116. Epub 2024 Jan 12.
To investigate the effects of blood pumps operated in different modes on nonphysiologic flow patterns, cell and protein function, and the risk of bleeding, thrombosis, and hemolysis, an extracorporeal blood pump (CentriMag) was operated in three clinical modalities including heart failure (HF), venous-venous (V-V) extracorporeal membrane oxygenation (ECMO), and venous-arterial (V-A) ECMO. Computational fluid dynamics (CFD) methods and coupled hemolysis models as well as recently developed bleeding and thrombosis models associated with changes in platelet and von Willebrand factor (vWF) function were used to predict hydraulic performance and hemocompatibility. The V-A ECMO mode had the highest flow losses and shear stress levels, the V-V ECMO mode was intermediate, and the HF mode was the lowest. Different nonphysiologic flow patterns altered cell/protein morphology and function. The V-A ECMO mode resulted in the highest levels of platelet activation, receptor shedding, vWF unfolding, and high molecular weight multimers vWF (HMWM-vWF) degradation, leading to the lowest platelet adhesion and the highest vWF binding capacity, intermediate in the V-V ECMO mode, and opposite in the HF mode. The V-A ECMO mode resulted in the highest risk of bleeding, thrombosis, and hemolysis, with the V-V ECMO mode intermediate and the HF mode lowest. These findings are supported by published experimental or clinical statistics. Further studies found that secondary blood flow passages resulted in the highest risk of blood damage. Nonphysiologic blood flow patterns were strongly associated with cell and protein function changing, blood damage, and complications.
为了研究不同模式运转的血泵对非生理流动模式、细胞和蛋白质功能以及出血、血栓形成和溶血风险的影响，采用体外血泵（CentriMag）在三种临床模式下运转，包括心力衰竭（HF）、静脉-静脉（V-V）体外膜肺氧合（ECMO）和静脉-动脉（V-A）ECMO。计算流体动力学（CFD）方法和耦合溶血模型以及最近开发的与血小板和血管性血友病因子（vWF）功能变化相关的出血和血栓形成模型，用于预测水力性能和血液相容性。V-A ECMO 模式的流动损失和剪切应力水平最高，V-V ECMO 模式居中，HF 模式最低。不同的非生理流动模式改变了细胞/蛋白质的形态和功能。V-A ECMO 模式导致血小板活化、受体脱落、vWF 展开和高分子量多聚体 vWF（HMWM-vWF）降解水平最高，导致血小板黏附最低和 vWF 结合能力最高，V-V ECMO 模式居中，HF 模式相反。V-A ECMO 模式导致出血、血栓形成和溶血的风险最高，V-V ECMO 模式居中，HF 模式最低。这些发现得到了已发表的实验或临床统计数据的支持。进一步的研究发现，次要血流通道导致血液损伤的风险最高。非生理血流模式与细胞和蛋白质功能变化、血液损伤和并发症密切相关。
