Computational fluid dynamics analysis of surgical adjustment of left ventricular assist device implantation to minimise stroke risk

Background. Currently, mechanical support is the most promising alternative to cardiac transplantation. Ventricular assist devices (VADs) were originally used to provide mechanical circulatory support in patients awaiting planned heart transplantation (‘bridge-to-transplantation’ therapy). The success of short-term bridge devices led to clinical trials evaluating the clinical suitability of long-term support (‘destination’ therapy) with left ventricular assist devices (LVADs). The first larger scale, randomised trial that tested long-term support with an LVAD reported a 44% reduction in the risk of stroke or death in patients with an LVAD. In spite of the success of LVADs as bridge-to-transplantation and long-term support, patients managed by these devices are still at risk of several adverse events. The most devastating complication is caused by embolisation of thrombi formed within the LVAD or inside the heart into the brain. Prevention of thrombi formation is attempted through anticoagulation managemen...