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Computational evaluation of the thrombogenic potential of a hollow-fiber oxygenator with integrated heat exchanger during extracorporeal circulation

机译：体外循环中集成热交换器中空纤维氧合器的血栓形成潜力的计算评价

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摘要

The onset of thromboembolic phenomena in blood oxygenators, even in the presence of adequate anticoagulant strategies, is a relevant concern during extracorporeal circulation (ECC). For this reason, the evaluation of the thrombogenic potential associated with extracorporeal membrane oxygenators should play a critical role into the preclinical design process of these devices. This study extends the use of computational fluid dynamics simulations to guide the hemodynamic design optimization of oxygenators and evaluate their thrombogenic potential during ECC. The computational analysis accounted for both macro- (i.e., vortex formation) and micro-scale (i.e., flow-induced platelet activation) phenomena affecting the performances of a hollow-fiber membrane oxygenator with integrated heat exchanger. A multiscale Lagrangian approach was adopted to infer the trajectory and loading history experienced by platelet-like particles in the entire device and in a repetitive subunit of the fiber bundles. The loading history was incorporated into a damage accumulation model in order to estimate the platelet activation state (PAS) associated with repeated passes of the blood within the device. Our results highlighted the presence of blood stagnation areas in the inlet section that significantly increased the platelet activation levels in particles remaining trapped in this region. The order of magnitude of PAS in the device was the same as the one calculated for the components of the ECC tubing system, chosen as a term of comparison for their extensive diffusion. Interpolating the mean PAS values with respect to the number of passes, we obtained a straightforward prediction of the thrombogenic potential as a function of the duration of ECC.
机译：血液充氧器中血栓栓塞现象的发生，即使存在足够的抗凝策略，也是体外循环（ECC）期间的一个相关问题。因此，与体外膜充氧器相关的血栓形成潜力的评估应在这些设备的临床前设计过程中发挥关键作用。这项研究扩展了计算流体动力学模拟的用途，以指导充氧器的血液动力学设计优化并评估其在ECC期间的血栓形成潜力。计算分析考虑了影响集成热交换器的中空纤维膜充氧器性能的宏观（即，涡旋形成）和微观（即，流动引起的血小板活化）现象。采用了多尺度拉格朗日方法来推断整个设备中以及纤维束的重复亚基中的类血小板颗粒所经历的轨迹和加载历史。为了将与装置内血液的重复通过相关联的血小板活化状态（PAS）估计到损伤累积模型中，将装载历史记录合并到损伤累积模型中。我们的结果突出显示了入口部分存在血流停滞区域，该区域显着增加了残留在该区域的颗粒中的血小板活化水平。设备中PAS的数量级与为ECC管道系统的组件计算的数量级相同，被选作它们广泛扩散的比较术语。插值相对于通过次数的平均PAS值，我们获得了血栓形成潜能作为ECC持续时间函数的直接预测。

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