Tarafder Anik, Han Dong, Griffith Bartley P, Wu Zhongjun J
From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland.
ASAIO J. 2025 Jun 23. doi: 10.1097/MAT.0000000000002487.
Although durable mechanical circulatory support (MCS) has been promising in supporting advanced heart failure patients, device hemocompatibility-related complications remain a major concern compared with heart transplantation. We investigated the blood damage potential of the three most recent clinically available, implantable MCS devices and compared their biocompatibility performance. One axial pump (HeartMate II) and two centrifugal pumps (HeartMate 3 and BrioVAD) were chosen for this study. In vitro experiments with healthy human blood and computational fluid dynamics simulations were performed to compare high-mechanical shear-induced blood trauma in these devices. Regions of higher shear stresses were identified. Power-law relations between shear stress and blood damage were implemented to assess hemolysis, platelet activation, and platelet receptor shedding of key functional receptors (glycoprotein [GP] Ibα, and GPVI) caused by these devices. HeartMate II caused the most severe blood trauma among these three devices, producing an order of magnitude larger values for hemolysis and platelet activation compared with HeartMate 3 and BrioVAD. Also, HeartMate II consistently exhibited the highest levels of receptor shedding, approximately double those caused by the HeartMate 3 and BrioVAD. The HeartMate 3 and BrioVAD centrifugal pumps showed similar performance in terms of blood damage.
尽管持久的机械循环支持（MCS）在支持晚期心力衰竭患者方面前景广阔，但与心脏移植相比，与设备血液相容性相关的并发症仍然是一个主要问题。我们研究了三种最新临床可用的可植入MCS设备的血液损伤潜力，并比较了它们的生物相容性性能。本研究选择了一台轴流泵（HeartMate II）和两台离心泵（HeartMate 3和BrioVAD）。进行了健康人血液的体外实验和计算流体动力学模拟，以比较这些设备中高机械剪切诱导的血液损伤。确定了较高剪切应力区域。采用剪切应力与血液损伤之间的幂律关系来评估这些设备引起的溶血、血小板活化以及关键功能受体（糖蛋白[GP]Ibα和GPVI）的血小板受体脱落。在这三种设备中，HeartMate II造成的血液损伤最严重，与HeartMate 3和BrioVAD相比，其溶血和血小板活化值高出一个数量级。此外，HeartMate II始终表现出最高水平的受体脱落，约为HeartMate 3和BrioVAD引起的受体脱落水平的两倍。HeartMate 3和BrioVAD离心泵在血液损伤方面表现出相似的性能。
