Biomechanical effects of the working modes of LVADs on the aortic valve: A primary numerical study

Aortic valve diseases caused by the support from left ventricular assist devices (LVADs) have attracted increasing attention due to the wide application of the LVADs. However, the biomechanical effects of the working modes of LVADs on the aortic valve are still poorly understood. Hence, in this study, these biomechanical effects are investigated using a novel fluid-structure interaction method, which combines the lattice Boltzmann and the finite element methods. On the basis of the clinical practice, three working modes of LVADs, namely, the constant flow, co-pulse, and counter pulse modes, are chosen. Results demonstrate that the working mode of LVADs is an important factor as it can change the biomechanical states of the aortic valve and the hemodynamic environment in the aortic root directly. Compared with the constant flow mode, the two other working modes can provide better biomechanical effects on the aortic valve. However, the advantages of the co-pulse and the counter pulse modes on the aortic valve are not the same. The LVADs in the co-pulse mode can remarkable reduce the pressure load of the leaflets during the diastolic phase (maximum stress: co-pulse mode, 0.85 MPa; constant flow mode, 1.23 MPa; counter pulse mode, 1.50 MPa). By contrast, the LVADs in the counter pulse mode can achieve the highest effective orifice area of the aortic valve (co-pulse mode: 0.12 cm(2), constant flow mode: 0.17 cm(2), counter pulse mode: 0.25 cm(2)). In sum, the co-pulse mode is suitable for patients with certain cardiac function, because this mode keeps the valve open intermittently and reduces the pressure load on the aortic leaflets during the diastolic phase to prevent valve remodeling. By contrast, the counter pulse mode is suitable for patients with severely impaired cardiac function, because this mode keeps the valve open as much as possible and provides high blood perfusion. (C) 2020 Elsevier B.V. All rights reserved.