Shear stress alterations in the celiac trunk of patients with a continuous-flow left ventricular assist device as shown by in-silico and in-vitro flow analyses

Leonardo D'Acquisto, Valentina Agnese, Salvatore Pasta, Diego Bellavia, Francesco Scardulla, Francesco Clemenza, Michele Pilato, Sergio Sciacca, Christian Vergara, Diego Bellavia, Alfio Quarteroni, Salvatore Pasta, Valentina Agnese

Risultato della ricerca: Article

6 Citazioni (Scopus)

Abstract

Background The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. Methods Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. Results Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 ± 5.45 Pa, with an average flow velocity of 0.57 ± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 ± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk (R = 0.9), which may increase vulnerability of this vessel to bleeding. Conclusions Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients.
Lingua originaleEnglish
pagine (da-a)906-913
Numero di pagine8
RivistaTHE JOURNAL OF HEART AND LUNG TRANSPLANTATION
Volume36
Stato di pubblicazionePublished - 2017

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Heart-Assist Devices
Computer Simulation
Abdomen
Heart Failure
Hemodynamics
Hemorrhage
Hepatic Artery
Abdominal Aorta
In Vitro Techniques
Stomach
Arteries
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cita questo

Shear stress alterations in the celiac trunk of patients with a continuous-flow left ventricular assist device as shown by in-silico and in-vitro flow analyses. / D'Acquisto, Leonardo; Agnese, Valentina; Pasta, Salvatore; Bellavia, Diego; Scardulla, Francesco; Clemenza, Francesco; Pilato, Michele; Sciacca, Sergio; Vergara, Christian; Bellavia, Diego; Quarteroni, Alfio; Pasta, Salvatore; Agnese, Valentina.

In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION, Vol. 36, 2017, pag. 906-913.

Risultato della ricerca: Article

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title = "Shear stress alterations in the celiac trunk of patients with a continuous-flow left ventricular assist device as shown by in-silico and in-vitro flow analyses",
abstract = "Background The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. Methods Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. Results Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 {\^A}± 5.45 Pa, with an average flow velocity of 0.57 {\^A}± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 {\^A}± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk (R = 0.9), which may increase vulnerability of this vessel to bleeding. Conclusions Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients.",
author = "Leonardo D'Acquisto and Valentina Agnese and Salvatore Pasta and Diego Bellavia and Francesco Scardulla and Francesco Clemenza and Michele Pilato and Sergio Sciacca and Christian Vergara and Diego Bellavia and Alfio Quarteroni and Salvatore Pasta and Valentina Agnese",
year = "2017",
language = "English",
volume = "36",
pages = "906--913",
journal = "Journal of Heart and Lung Transplantation",
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TY - JOUR

T1 - Shear stress alterations in the celiac trunk of patients with a continuous-flow left ventricular assist device as shown by in-silico and in-vitro flow analyses

AU - D'Acquisto, Leonardo

AU - Agnese, Valentina

AU - Pasta, Salvatore

AU - Bellavia, Diego

AU - Scardulla, Francesco

AU - Clemenza, Francesco

AU - Pilato, Michele

AU - Sciacca, Sergio

AU - Vergara, Christian

AU - Bellavia, Diego

AU - Quarteroni, Alfio

AU - Pasta, Salvatore

AU - Agnese, Valentina

PY - 2017

Y1 - 2017

N2 - Background The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. Methods Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. Results Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 ± 5.45 Pa, with an average flow velocity of 0.57 ± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 ± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk (R = 0.9), which may increase vulnerability of this vessel to bleeding. Conclusions Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients.

AB - Background The use of left ventricular assist devices (LVADs) to treat advanced cardiac heart failure is constantly increasing, although this device leads to high risk for gastrointestinal bleeding. Methods Using in-silico flow analysis, we quantified hemodynamic alterations due to continuous-flow LVAD (HeartWare, Inc., Framingham, MA) in the celiac trunk and major branches of the abdominal aorta, and then explored the relationship between wall shear stress (WSS) and celiac trunk orientation. To assess outflow from the aortic branch, a 3-dimensional-printed patient-specific model of the celiac trunk reconstructed from an LVAD-supported patient was used to estimate echocardiographic outflow velocities under continuous-flow conditions, and then to calibrate computational simulations. Moreover, flow pattern and resulting WSS values were computed for 5 patients with LVAD implantation. Results Peak WSS values were estimated on the 3 branches of the celiac trunk and the LVAD cannula. The mean WSSs demonstrated that the left gastric artery underwent the highest WSS of 9.08 ± 5.45 Pa, with an average flow velocity of 0.57 ± 0.25 m/s compared with that of other vessel districts. The common hepatic artery had a less critical WSS of 4.58 ± 1.77 Pa. A positive correlation was found between the celiac trunk angulation and the WSS stress just distal to the ostium of the celiac trunk (R = 0.9), which may increase vulnerability of this vessel to bleeding. Conclusions Although further studies are needed to confirm these findings in a larger patient cohort, computational flow simulations may enhance the information of clinical image data and may have an application in clinical investigations of hemodynamic changes in LVAD-supported patients.

UR - http://hdl.handle.net/10447/250568

UR - http://www.elsevier.com/locate/healun

M3 - Article

VL - 36

SP - 906

EP - 913

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

ER -