Relative blood damage in the three phases of a prosthetic heart valve flow cycle

Blood flow through a prosthetic heart valve operating in a ventricular assist device can be subdivided into three phases: a) forward flow through an open valve, b) rapid valve closure, and c) regurgitant back flow through a closed valve. Recent studies of fluid stresses in the Penn State Electric Left Ventricular Assist Device (PS LVAD) operating under physiologic conditions indicate that Reynolds stresses of possibly hemolytic magnitude may exist in the valve area. Although several studies have been made of the fluid stresses seen in forward flow through an open valve, few have looked at valve closure or backflow, and none have related these stresses directly to blood damage. In this study, novel in vitro blood flow loops were developed to allow for the separate analysis of the three flow phases of a Bjork- Shiley monostrut Delrin disk valve operating in a PS LVAD. Forward flow through fully open aortic and mitral valves and backflow through closed valves are studied separately in flow loops driven by a roller pump with the LVAD acting as a valve housing and compliance vessel. Valve closure is investigated with a PS LVAD operating in a low volume mock circulatory loop characterized by cavitation potential through stroboscopic videography of this mock loop, using saline as the working fluid. Rate of hemolysis, characterized by the index of hemolysis, IH, is determined for each of the three flow loops charged with fresh porcine blood. The blood studies indicate that the hemolytic effects of back flow are comparable to forward loop, contributing significantly to the overall IH of an LVAD operating in a mock loop under conditions in which cavitation is not expected. The index of hemolysis was shown to be a strong function of cavitation potential, increasing markedly with the expected cavitation cycle duration.