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WIREs Syst Biol Med
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Recent advances in computational methodology for simulation of mechanical circulatory assist devices

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Ventricular assist devices (VADs) provide mechanical circulatory support to offload the work of one or both ventricles during heart failure. They are used in the clinical setting as destination therapy, as bridge to transplant, or more recently as bridge to recovery to allow for myocardial remodeling. Recent developments in computational simulation allow for detailed assessment of VAD hemodynamics for device design and optimization for both children and adults. Here, we provide a focused review of the recent literature on finite element methods and optimization for VAD simulations. As VAD designs typically fall into two categories, pulsatile and continuous flow devices, we separately address computational challenges of both types of designs, and the interaction with the circulatory system with three representative case studies. In particular, we focus on recent advancements in finite element methodology that have increased the fidelity of VAD simulations. We outline key challenges, which extend to the incorporation of biological response such as thrombosis and hemolysis, as well as shape optimization methods and challenges in computational methodology. WIREs Syst Biol Med 2014, 6:169–188. doi: 10.1002/wsbm.1260 This article is categorized under: Analytical and Computational Methods > Computational Methods Translational, Genomic, and Systems Medicine > Translational Medicine

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Flow in a patient‐specific thoracic aorta with left ventricular assist device (LVAD). Boundary conditions for the fluid mechanics domain. Ca, a = 1, 2, 3, 4, are the resistance constants, σn is the normal component of the traction vector, q is the volumetric flow rate, and p0 is responsible for setting the physiological pressure level in the blood vessels. The LVAD branch is attached on the right side of the vessel, modeling the LVAD implantation in a descending configuration.
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Shear rate (103 second−1) for slices through the DeBakey geometry at t = 88 milliseconds. Two designs are compared: reducing the initial gap width by 0.25 din (top) and increasing the gap width by 0.25 din (bottom).
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Modification of the gap width between impeller and diffuser and resulting objective function values for shear (empty markers) and pressure head (solid markers). Values are normalized by the respective value for the initial design.
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Model of a DeBakey left ventricular assist device. Selection of the handle region (green) and the modeling region (blue) in Open Flipper in order to modify the gap width between impeller and diffuser.
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Blood flow speed (cm/second) at 0.5 cm above the plane separating the blood and air chambers. In‐plane vectors shown during (a) expel stage (t = 0.14 seconds) and (b) fill stage (t = 0.665 seconds).
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The membrane deformed configuration at time (a) t = 0 second, (b) t = 0.15 seconds, (c) t = 0.3 seconds, and (d) t = 0.525 seconds.
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Top view of the membrane deformed configuration at t = 0.15 seconds. Despite the complex deformation pattern, the wrinkles on the membrane surface are smooth.
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Flow speed (cm/second) in the deformed blood chamber configuration at t = 0.15 seconds.
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The pulsatile ventricular assist device (PVAD) computational domain, with the blood domain in light color and the air domain in dark color. The inlet and outlet face of the blood chamber are labeled 1 and 2, respectively. The air‐side inlet/outlet face is labeled 3.
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Schematic of the device thrombogenicity emulation (DTE) framework. (Bottom left) Representative platelet trajectories in the flow field of a ventricular assist device (DeBakey VAD); (bottom right) emulation of stress‐loading history of typical platelet trajectories in the hemodynamic shearing device (HSD); (top right) computer‐controlled HSD where platelets are exposed to uniform shear stress; (top left) principle of the modified prothrombinase assay used to measure the activity state of platelets sampled from the HSD. (Reprinted with permission from Ref . Copyright 2012 Public Library of Science)
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Flow in a patient‐specific thoracic aorta with left ventricular assist device (LVAD). Mean wall shear stress (WSS) vectors and the magnitude of the mean WSS.
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Flow in a patient‐specific thoracic aorta with left ventricular assist device (LVAD). Flow streamlines at peak systole in the LVAD attachment region. LVAD is operating at the highest setting.
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