Computational fluid dynamics in patients with continuous-flow left ventricular assist device support show hemodynamic alterations in the ascending aorta

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Manuel J. Antunes, MD, PhD, DSc

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Computational fluid dynamics in patients with continuous-flow left ventricular assist device support show hemodynamic alterations in the ascending aorta Christof Karmonik, PhD, Sasan Partovi, MD, Matthias Loebe, MD, PhD, Bastian Schmack, MD, Alexander Weymann, MD, Alan B. Lumsden, MD, Matthias Karck, MD, PhD, Arjang Ruhparwar, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 4, Pages 1326-1333.e1 (April 2014) DOI: 10.1016/j.jtcvs.2013.09.069 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Visualization of geometry of the 5 computational models used in this study. A, View from the head looking down on the arch. On the left computational model (patient 1), the definition of the azimuth angle is shown: It was defined as the angle between the line (m) through the midpoints of the ascending (P1, white dot) and descending (P2, white dot) thoracic aorta and the midline of the distal LVAD outflow graft (g). B, Lateral view displaying geometric relationship between the wall of the ascending aorta and the LVAD graft anastomosis, which was quantified by the polar angle (values listed below models). On the computational model for patient 1 (left), the definition of the polar angle is shown: It was defined as the angle between the midline of the distal LVAD outflow tract (g) and the midline of the ascending aorta (a). The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1326-1333.e1DOI: (10.1016/j.jtcvs.2013.09.069) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Contours of dynamic pressure. B, Streamlines. C, WSS for systole. Focal regions of high pressure on the contralateral wall can be appreciated in cases with high azimuth angle (cases 1 and 3, filled arrows) where there is an impingement zone of the flow at the contralateral wall. In addition to these zones, focal regions of high pressures were found on the ipsilateral wall in cases with low azimuth angle (cases 2 and 5, open arrows) immediately at the anastomosis site. Disturbed flow in the ascending aorta can be appreciated for all cases as visualized by the unordered streamlines. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1326-1333.e1DOI: (10.1016/j.jtcvs.2013.09.069) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Correlation plots illustrating the linear relationships between geometric (azimuth and polar angle) and hemodynamic (pressure, WSS, and turbulence dissipation) parameters. WSS, Wall shear stress. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1326-1333.e1DOI: (10.1016/j.jtcvs.2013.09.069) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Results of an exploratory linear discrimination analysis for 2 scenarios: A, Bar plots illustrate values of the linear discriminants for AI (left) and IE (right). B, Post hoc Student t test for the hemodynamic parameters with the highest discriminants for AI (left) and IE (right). A good separation between patients with and without AI can be appreciated corresponding to large value for the velocity magnitude as the dominating linear discriminant (filled arrows); a similar finding is absent for IE. AI, Aortic insufficiency; IE, ischemic event; WSS, wall shear stress. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1326-1333.e1DOI: (10.1016/j.jtcvs.2013.09.069) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Contours of dynamic pressure (A), stream lines (B), and WSS (C) in a CFD simulation for case 1, where the contribution from the native heart was removed (velocity at the aortic root set to zero). The results shown should be compared with the left column of Figure 2. Good qualitative, quantitative agreement of the main features in the distribution of the WSS, pressure, and stream lines is apparent. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1326-1333.e1DOI: (10.1016/j.jtcvs.2013.09.069) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions