Hemodynamics of an End-to-Side Anastomotic Graft for a Pulsatile Pediatric Ventricular Assist Device

Abstract

Numerical simulations are performed to investigate the flow within the end-to-side proximal anastomosis of a pulsatile pediatric ventricular assist device (PVAD) to an aorta. The anastomotic model is constructed from a patient-specific pediatric aorta. The three great vessels originating from the aortic arch— brachiocephalic (innominate), left common carotid, and left subclavian arteries—are included. An implicit large eddy simulation method based on a finite volume approach is used to study the resulting turbulent flow. A resistance boundary condition is applied at each branch outlet to study flow splitting. The PVAD anastomosis is found to alter the aortic flow dramatically. More flow is diverted into the great vessels with the PVAD support. Turbulence is found in the jet impingement area at peak systole for 100% bypass, and a maximum principal normal Reynolds stress of 7081 dyn/cm2 is estimated based on ten flow cycles. This may be high enough to cause hemolysis and platelet activation. Regions prone to intimal hyperplasia are identified by combining the time-averaged wall shear stress and oscillatory shear index. These regions are found to vary, depending on the percentage of the flow bypass.