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• W4384567721 abstract "<h3>Introduction</h3> The incidence of heart failure as a result of congenital heart defects is between 1 and 2 per 1000 live births.¹ Cardiomyopathy also causes heart failure with symptoms in 1 per 10,000 children under 1 year old.² Ventricular Assist Devices (VADs) can keep patients alive until a donor heart is available, however the options for paediatric patients are limited. The Berlin Heart EXCOR is an extracorporeal, pneumatically driven, pulsatile flow VAD; although designed for paediatric patients it still has a 20-30% risk of neurological complications.³ The only alternative is an adult VAD, such as the HeartMate II, HVAD or HeartMate 3. However, the lower cardiac output and pressure require a reduction in the speed such that the pump is operating off-design, leading to increased blood residence time and thrombosis; additionally size restrictions limit these to children of at least about 13 kg.⁴ The need for a fully implantable LVAD, designed specifically for paediatric patients is urgent and the aim of the NeoVAD is to provide a safe, long-term, bridge-to-transplant therapy that meets this specific need. The target population is infants between 5 and 20 kg with a variable operating point depending on the patient size with the upper end being 70 mmHg and 2 l/min. The pump uses axial flow with a rotating, magnetically-levitated impeller powered by a blood washed motor (figure 1). To reduce blood damage, such as haemolysis, in the motor gap a higher secondary flow is desirable, so the aim of this study was to investigate the influence of the inlet window geometry and the momentum of a secondary impeller, on flow through the NeoVAD. <h3>Methods</h3> The flow path through the NeoVAD was extracted from the CAD. The NeoVAD was situated in an ellipsoid representative of a paediatric ventricle and the main impeller-diffuser was simulated as a momentum source equivalent to that which would give the pressure-flow curve obtained in prototypes and simulations.⁵ The dimensions of the main windows were altered to create a series of different NeoVAD geometries. A range of values for a momentum source approximating that of a second impeller located at the secondary inlet were simulated. Ansys Meshing and Ansys CFX were used for meshing and solving the equations of fluid motion. <h3>Results</h3> As the area of the main inlet windows was reduced the pressure at the main impeller decreased, creating a pressure gradient across the motor, and so increasing the flow rate there (figure 2). However, extremely small window areas resulted in pressure drops at the inlet which exceeded the pressure head created by the main impeller. <h3>Conclusions</h3> The maximum flow rate through the motor, which could be achieved without excessive pressure drop was around 20 ml/min. At operating conditions for the smallest infants this results in long exposures which are potentially haemolytic, suggesting it will be necessary to use a secondary impeller. Future work will investigate how pulsatile flow due to the beating ventricle influences these results by coupling the 3D CFD with a 0D lumped parameter model of the circulation. <h3>References</h3> Kay, <i>et al. Am Heart J</i>, 2001;<b>142</b>:923‘8. Andrews, <i>et al. Circulation</i>, 2008;<b>117</b>:79‘84. George, <i>et al. Heart Fail Rev</i>, 2022;<b>27</b>:903-913. Chan, <i>et al. Artif Organs</i> 2018;<b>42</b>:1028‘1034. Nissim, <i>et al. Research Square</i> 2023; rs-2405001 <h3>Conflict of Interest</h3> no" @default.
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• W4384567721 date "2023-06-01" @default.
• W4384567721 modified "2023-09-26" @default.
• W4384567721 title "BS81 Design of the blood flow path for the neovad: an implantable ventricular assist device for infants" @default.
• W4384567721 doi "https://doi.org/10.1136/heartjnl-2023-bcs.294" @default.
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