Numerical analysis of aortic hemodynamics under the support of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump

Kaiyun Gu; Zhiyuan Guan; Xuanqi Lin; Yunzhen Feng; Jieli Feng; Yujie Yang; Zhe Zhang; Yu Chang; Yunpeng Ling; Feng Wan

doi:10.1016/j.cmpb.2019.105041

Numerical analysis of aortic hemodynamics under the support of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump

Comput Methods Programs Biomed. 2019 Dec:182:105041. doi: 10.1016/j.cmpb.2019.105041. Epub 2019 Aug 19.

Authors

Kaiyun Gu¹, Zhiyuan Guan¹, Xuanqi Lin², Yunzhen Feng³, Jieli Feng¹, Yujie Yang¹, Zhe Zhang⁴, Yu Chang⁵, Yunpeng Ling¹, Feng Wan³

Affiliations

¹ Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China.
² College of Life Science and Bioengineering, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 200120, China.
³ Shanghai East Hospital, Tongji University, 150 Jimo Rd., Pudong District, Shanghai 100124, China.
⁴ Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China. Electronic address: zhangzhe@bjmu.edu.cn.
⁵ College of Life Science and Bioengineering, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 200120, China. Electronic address: bme@bjut.edu.cn.

PMID: 31465978
DOI: 10.1016/j.cmpb.2019.105041

Abstract

Background and objective: A gap still exists in the hemodynamic effect of intra-aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and VA-ECMO plus IABP on the blood perfusion of the coronary artery, brain, and lower limb; the relation between heart flow and ECMO flow; and the wall stress of vessels.

Methods: A finite-element model of the aorta, ECMO, and IABP was proposed to calculate the mechanical response via fluid-structure interaction. Heart failure (HF), IABP, ECMO, and ECMO plus IABP were utilized to study the effect of support models.

Results: For the pressure curve, VA-ECMO weakened the dicrotic notch of pressure compared with HF and the pulsatile index (0.494 vs. 0.706 vs. 0.471 vs. 0.613). IABP, ECMO, and ECMO plus IABP increased the perfusion of the coronary, brain, and renal artery compared with HF. However, ECMO and ECMO plus IABP clearly reduced the blood flow of the left arteria femoralis compared to that of the right arteria femoralis (ECMO: 194.04 vs. 730.80 mL/min; ECMO plus IABP: 342.15 vs. 947.22 mL/min). In addition, the flow of ECMO accessed the renal artery more than the left ventricular flow. Greater ventricular flow perfused to the renal artery at a diastolic period for ECMO plus IABP, especially at the time points of 2.192 s and 2.304 s. Compared to the velocity distribution with ECMO, the flow of the right arteria femoralis was increased in the process of IABP-on. According to these four cases, the stress of the vascular wall was increased for ECMO support at the systolic period. The peak wall stress of ECMO is increased by 20% at 1.68 s.

Conclusions: ECMO plus IABP is more conducive to the blood supply than other cases from the result of numerical simulation. The location of blood intersection was generated in the region of the renal artery, which is estimated carefully.

Keywords: Fluid–structure interaction; Hemodynamics; Intra-aortic balloon pump; Venoarterial extracorporeal membrane oxygenation.

MeSH terms

Aorta / physiology*
Extracorporeal Membrane Oxygenation*
Finite Element Analysis
Hemodynamics*
Humans
Intra-Aortic Balloon Pumping / instrumentation*