Microfluidic emulation of mechanical circulatory support device shear-mediated platelet activation

Thrombosis of ventricular assist devices (VADs) compromises their performance, with associated risks of systemic embolization, stroke, pump stop and possible death. Anti-thrombotic (AT) drugs, utilized to limit thrombosis, are largely dosed empirically, with limited testing of their efficacy. Further, such testing, if performed, typically examines efficacy under static conditions, which is not reflective of actual shear-mediated flow. Here we adopted our previously developed Device Thrombogenicity Emulation methodology to design microfluidic platforms able to emulate representative shear stress profiles of mechanical circulatory support (MCS) devices. Our long-term goal is to utilize these systems for point-of-care (POC) personalized testing of AT efficacy under specific, individual shear profiles. First, we designed different types of microfluidic channels able to replicate sample shear stress patterns observed in MCS devices. Second, we explored the flexibility of microfluidic technology in generating dynamic shear stress profiles by modulating the geometrical features of the channels. Finally, we designed microfluidic channel systems able to emulate the shear stress profiles of two commercial VADs. From CFD analyses, the VAD-emulating microfluidic systems were able to replicate the main characteristics of the shear stress waveforms of the macroscale VADs (i.e., shear stress peaks and duration). Our results establish the basis for development of a lab-on-chip POC system able to perform device-specific and patient-specific platelet activation state assays.

[1]  A. Redaelli,et al.  Computational evaluation of the thrombogenic potential of a hollow-fiber oxygenator with integrated heat exchanger during extracorporeal circulation , 2012, Biomechanics and Modeling in Mechanobiology.

[2]  Shmuel Einav,et al.  Device Thrombogenicity Emulation: A Novel Method for Optimizing Mechanical Circulatory Support Device Thromboresistance , 2012, PloS one.

[3]  E. Herrmann,et al.  Point-of-Care Coagulation Testing for Assessment of the Pharmacodynamic Anticoagulant Effect of Direct Oral Anticoagulant , 2014, Therapeutic drug monitoring.

[4]  Yangchao Tian,et al.  Fabrication of high-aspect-ratio microstructures using SU8 photoresist , 2005 .

[5]  P. Perrotta,et al.  Platelet activation in a circulating flow loop: combined effects of shear stress and exposure time , 2003, Platelets.

[6]  J Jesty,et al.  Acetylated prothrombin as a substrate in the measurement of the procoagulant activity of platelets: elimination of the feedback activation of platelets by thrombin. , 1999, Analytical biochemistry.

[7]  Ranjit John,et al.  Bleeding and Thrombosis in Patients With Continuous-Flow Ventricular Assist Devices , 2012, Circulation.

[8]  Shmuel Einav,et al.  Thromboresistance comparison of the HeartMate II ventricular assist device with the device thrombogenicity emulation- optimized HeartAssist 5 VAD. , 2014, Journal of biomechanical engineering.

[9]  David N. Ku,et al.  Microfluidic Thrombosis under Multiple Shear Rates and Antiplatelet Therapy Doses , 2014, PloS one.

[10]  G. Whitesides The origins and the future of microfluidics , 2006, Nature.

[11]  M. Mehra,et al.  The vexing problem of thrombosis in long-term mechanical circulatory support. , 2014, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[12]  Alberto Redaelli,et al.  Platelet Activation Due to Hemodynamic Shear Stresses: Damage Accumulation Model and Comparison to In Vitro Measurements , 2008, ASAIO journal.

[13]  A. Groisman,et al.  Microfluidic devices for studies of shear-dependent platelet adhesion. , 2008, Lab on a chip.

[14]  Nader Moazami,et al.  Unexpected abrupt increase in left ventricular assist device thrombosis. , 2014, The New England journal of medicine.

[15]  Matthaeus,et al.  Recovery of the Navier-Stokes equations using a lattice-gas Boltzmann method. , 1992, Physical review. A, Atomic, molecular, and optical physics.

[16]  Danny Bluestein,et al.  Flow-induced platelet activation and damage accumulation in a mechanical heart valve: numerical studies. , 2007, Artificial organs.

[17]  H Reul,et al.  Assessment of hemolysis related quantities in a microaxial blood pump by computational fluid dynamics. , 2001, Artificial organs.

[18]  Shmuel Einav,et al.  Device Thrombogenicity Emulator (DTE)--design optimization methodology for cardiovascular devices: a study in two bileaflet MHV designs. , 2010, Journal of biomechanics.

[19]  S. Diamond,et al.  Detection of platelet sensitivity to inhibitors of COX-1, P2Y₁, and P2Y₁₂ using a whole blood microfluidic flow assay. , 2014, Thrombosis research.

[20]  M. Givertz,et al.  Mechanical Circulatory Support for Advanced Heart Failure: Patients and Technology in Evolution , 2012, Circulation.

[21]  M. Murray,et al.  The Pharmacotherapy Implications of Ventricular Assist Device in the Patient With End-Stage Heart Failure , 2012, Journal of pharmacy practice.

[22]  Danny Bluestein,et al.  Biological effects of dynamic shear stress in cardiovascular pathologies and devices , 2008, Expert review of medical devices.

[23]  Cyrus K. Aidun,et al.  Numerical Investigation of the Effects of Channel Geometry on Platelet Activation and Blood Damage , 2011, Annals of Biomedical Engineering.

[24]  Shmuel Einav,et al.  Design Optimization of a Mechanical Heart Valve for Reducing Valve Thrombogenicity—A Case Study with ATS Valve , 2010, ASAIO journal.

[25]  I. Mezić,et al.  Chaotic Mixer for Microchannels , 2002, Science.

[26]  S. A. Morsi,et al.  An investigation of particle trajectories in two-phase flow systems , 1972, Journal of Fluid Mechanics.

[27]  J. Friend,et al.  Fabrication of microfluidic devices using polydimethylsiloxane. , 2010, Biomicrofluidics.