Device Thrombogenicity Emulation A Novel Method for Optimizing Mechanical Circulatory Support Device Thromboresistance 英文参考文献.docVIP

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Device Thrombogenicity Emulation A Novel Method for Optimizing Mechanical Circulatory Support Device Thromboresistance 英文参考文献.doc

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Device Thrombogenicity Emulation A Novel Method for Optimizing Mechanical Circulatory Support Device Thromboresistance 英文参考文献

DeviceThrombogenicityEmulation:ANovelMethodfor OptimizingMechanicalCirculatorySupportDevice Thromboresistance GauravGirdhar1,MichalisXenos1,YaredAlemu1,Wei-CheChiu1,BryanE.Lynch3,JolyonJesty2 ,Shmuel Einav1,MarvinJ.Slepian4,DannyBluestein1* 1DepartmentofBiomedicalEngineering,StonyBrookUniversity,StonyBrook,NewYork,UnitedStatesofAmerica,2DepartmentofHematology,StonyBrookUniversity, StonyBrook,NewYork,UnitedStatesofAmerica,3MicroMedCardiovascularInc.,Houston,Texas,UnitedStatesofAmerica,4SarverHeartCenter,UniversityofArizona, Tucson,Arizona,UnitedStatesofAmerica Abstract Mechanicalcirculatorysupport(MCS)devicesprovidebothshortandlongtermhemodynamicsupportforadvancedheart failure patients. Unfortunately these devices remain plagued by thromboembolic complications associated with chronic plateletactivation–mandatingcomplex,lifelonganticoagulationtherapy.Toaddresstheunmetneedforenhancingthe thromboresistance of these devices to extend their long term use, we developed a universal predictive methodology entitled Device Thrombogenicity Emulation (DTE) that facilitates optimizing the thrombogenic performance of any MCS device – ideally to a level that may obviate the need for mandatory anticoagulation. DTE combines in silico numerical simulationswithinvitromeasurementsbycorrelatingdevicehemodynamicswithplateletactivitycoagulationmarkers– before and after iterative design modifications aimed at achieving optimized thrombogenic performance. DTE proof-of- concept is demonstrated by comparing two rotary Left Ventricular Assist Devices (LVADs) (DeBakey vs HeartAssist 5, Micromed Houston, TX), the latter a version of the former following optimization of geometrical features implicated in device thrombogenicity. Cumulative stresses that may drive platelets beyond their activation threshold were calculated along multiple flow trajectories and collapsed into probability density functions (PDFs) representing the device ‘thrombogenic footprint’, indicating significantly reduced thr