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Blood pump

[Type the document subtitle]



Application of fluid mechanics to blood pumps for humans

UTS
5/31/2013

Steven Tran 11228184
Daniel Yip
Hong Liang
Victor Chang Leong

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Contents
1. Introduction ............................................................................................................ 0
2. Development of Blood Pumps ................................. Error! Bookmark not defined.
2.1 The Heart, a Blood Pump..................................................................................... 4
2.2 History of the blood pump ................................................................................... 5
3. Issues of Blood damage and blood clot ................................................................... 20
3.1 Blood clotting..................................................................................................... 20
3.2 Dangers of blood clotting................................................................................... 21
3.3 Ventricular Assist Devices and Blood Clots ...................................................... 21
3.4 Blood Damage ................................................................................................... 22
3.5 Mechanical Causes of Damage .......................................................................... 22
4. Comparison of key aspects pertaining to blood pumps of different designs and type
Error! Bookmark not defined.
4.1Axial flow pump ................................................. Error! Bookmark not defined.
4.2 Centrifugal pump ............................................... Error! Bookmark not defined.
4.3 Peristaltic pmp ................................................... Error! Bookmark not defined.
4.4 Extracorporeal Pump
4.5 Ventricular assist device(VAD).
5. Reliability ................................................................................................................. 18
5.1 Malfunction and reliability of the Heart ............................................................ 18
5.2 Heart Assistance Devices (Blood pumps) .......... Error! Bookmark not defined.
5.3 Reliability of the blood pumps .......................................................................... 19
6. Key Aspects in the Comparison of Blood pumps Vs Water pumpsError! Bookmark not
defined.
6.1 Efficiency ............................................................................................................. 8
6.2 Shear stress........................................................................................................... 9
6.3 Stagnation and Blood Clotting ........................................................................... 10
6.4 Blood turbulence ................................................................................................ 10
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6.5 Cavitation ........................................................................................................... 11
7. The issues that are dealt with Blood pumps and their solutionError! Bookmark not
defined.
7.1 Power Supply ..................................................................................................... 13
7.2 Flow rate & pressure .......................................................................................... 14
7.2.1 Solution
7.3 Biocompatibility
7.3.1 Solution
8. How fluids mechanics has been applied to help solve problems issues associated with
blood pumps ................................................................. Error! Bookmark not defined.
References .................................................................... Error! Bookmark not defined.



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1. Introduction

The human heart is a hollow muscle that pumps blood around body through blood vessels,
the heart is the most central part of the body, without it we cannot live. Over the past 100
years there has been a significant increase in heart disease in society. It is because of this
increase that has led to further research into alternatives and substitutes, in case the heart
fails. The result is blood pumps. The heart is the only organ that has been a struggle to
recreate artificially & there are still many people who are working on it to date.

The blood pump is a direct copy of the human heart, which is an understandably complex
muscle. The blood pump has taken almost 200 years to develop into the current mechanism it
is today, but these devices are far from perfect & it is because of this, that the research into
the blood pump continues, in hope that in the future it will be able to imitate the heart
perfectly. Currently, devices on the market will have to be sufficient to those who need heart
transplant, or currently undergoing open heart surgery.

This report will explore how the blood pump was made over many decades of research with
various design changes to reach to the current blood pump we have today which is in
practical use to save patients, and will also explore how the blood pump is related to fluid
mechanics.













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2. Development of Blood Pumps

To understand the development of blood pumps, we have to look at the heart itself, since
blood pumps are directly based off the heart.

2.1 The Heart, a Blood Pump
The heart is an important muscular organ, which, much like a pump can suffer from
blockages, breakdowns and constant care and repair. The heart can be split up into for
chambers. These are -

1. Right Atrium
2. Right Ventricle
3. Left Atrium
4. Left Ventricle












The two sides of the heart, the left and the right, pump two different types of blood. The right
side of the heart collects and pumps de-oxygenized blood to the lungs, it then separates the
oxygen and releases the carbon dioxide in the blood. The other side of the heart (left side),
collects and pumps the oxygen rich blood which came from the lungs, back into the body.


Figure 1 Conceptual cross-section of the human heart.
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The function of heart can be expressed simply. The process starts by filling the heart with
blood. Then, the left and right atrium contracts at the same time, causing the blood to be
pumped into the left and right ventricles. The ventricles follow a similar process, contracting
simultaneously, thus pumping the blood back into the body. The final process is the heart
relaxes, allowing it to be refilled with blood, repeating the cycle. This whole process makes
the heart beat, one beat equaling to one cycle. It is this process which allows the circulation
of the blood throughout the whole body.

The average heart beats over 100,000 times per day, and in one year the heart beats 38
million times. The average heart pumps 7,200 litres of blood per day, which equates to over
2,500,000 litres a year. Therefore it is a reasonable assumption that the average heart is put
under a large workload during its lifetime. The blood pump would have to be able to cope
with the same standards as a normal human heart. It is because of this that the development of
blood pumps is a very challenging project.
2.2 History of the blood pump
The original concept of the blood pump can be traced to 1813, by Le Gallois whose
experimentation lead to his suggestion that artificial circulation could sustain a function of
the body. In 1855, the first hand operated roller pump was created by Porter and Bradley. Le
Galloiss concept was proved later in 1858 by Eduard Brown-Sequard when his
experimentation proved that a neural response can be preserved by early maintenance of
oxygenated blood supply. In 1887, E. E. Allen designed and manufactured the first direct
blood transfusion pump, which they named it the surgical pump. Approximately 10 years
later in 1899, Truax made some modifications to Allens existing pump by installing one
more roller, which later became the first double roller pump. In the following decades, many
researchers, including Beck, Van Allen, Bayliss, Mller, Henry and Jouvelet, took the current
pump design and refined it. They also recommended the use of roller pumps for blood
transfusion and other applications. In 1934 a more modifications were made by DeBakey,
and were made into one of the first heart-lung machines which were constructed by Gibbon.
A year later in 1935 Fleisch made and used the first electrically powered roller pump, which
was a big step from the hand powered roller pumps.



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Figure 2 The Akutsu-Kloff heart

All the experimenting and testing over many decades were focused on the roller pump which
was a large piece of equipment and wasnt portable. This issue got scientists thinking of a
newer age blood pump that are a lot smaller compared to the previous designs and more
portable. In 1957 Akutsu and Kolff implanted the first artificial heart into a dog which was
able to keep the dog alive for 90 minutes. However none of these devices were fit enough to
accommodate the human circulatory system.





Then in 1964 that the Nation Heart Institute took a step forward in the development of a
working blood pump, by creating the Artificial Heart Program. This Program encouraged the
development & research into the blood pump, and similar devices. It was through this
program, which allowed the 1969 artificial heart to be produced. This heart was able to
sustain the life of a calf for approximately 44 hours.

Many devices in the decades following were designed and able to replace the human heart
temporarily but it wasnt until 1988 when a new program emerged, one that aimed to develop
an artificial blood pump that was completely independent of being replaced and would
survive much of the patients new project life. Development of this device (in particular the
AbiorCor) has taken even longer and first clinical tests were undertaken in 2001 where 7
patients were implanted with the device. Unfortunately 6 of the 7 died due to imperfections in
the device and from this a revised model was developed. The only survivor has doubled their
life expectancy and is still living today.

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Figure 3 - AbiorCor [Artificial heart]
The AbiorCor has one main issue associated with it. That is that although both artificial
Atrium chambers are able to be contracted at the same time, the Ventricular chambers are
not. The Ventricular chambers have been designed to alternate but still the blood pump is
able to push more than 14400 litres per day which works out to be double that of the average
human heart. Research and clinical testing is still in
the feasibility stage of this pump but should
hopefully be available to Heart Disease suffers
sometime in the near future.









As we can see, the initial idea to construct a blood pump to temporarily help perfusion during
surgery has led to a more innovative solution to the problem, and that is to construct a device
which replaces the heart. It is important to appreciate how the blood pump has come about
and that the blood pump is not just on device with one function and one outcome, but many
devices with differing functions and outcomes. Some of these devices are briefly mentioned
in this section but more are covered further into this document in greater detail.


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Figure2 - AbiorCor being implemented in surgery





3. Issues of Blood Damage and Blood Clot and Important
outstanding Issues Relating to Blood Pumps, and directions
for their Solutions

3.1 Blood Clotting
Blood clotting is an extremely important function in the human body. When blood
vessels are cut or damaged, the loss of blood must be quickly stopped in order to
avoid shock and even possibly death. This is stopped when the blood becomes solid
through a process called coagulation or clotting.

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When a blood vessel is damaged, platelets and proteins from plasma work together
and stick to the vessel wall or any rough or foreign surface. When this occurs,
chemicals such as adenosine diphophate and serotonin are released and this causes
positive feedback where additional platelets and chemicals are released. Once the
platelets have accumulated, the process where fibrinogen is converted to fibrin and
this causes the blood to clot. This also causes the accumulation of platelets to
increase and therefore allowing the clot to grow.

3.2 Dangers of Blood Clotting
As mentioned above, the process of blood clotting is extremely important in the
maintenance of a healthy body, however, blood clots can also cause damage in a
body. Normally, the body will naturally dissolve the blood clots after the damaged/
injured vessel is healed. Clots sometimes form on the inside of vessels without the
occurrence of an injury or when a wound is healed but the clot didnt naturally
dissolve. These clots are also referred to as thrombi, and when they are present inside
a blood vessel they can restrict the flow of blood. In small narrower vessels like veins
which carry back deoxygenated blood from the organ of the body, if an abnormal clot
forms in the vein, the clot may restrict the flow of blood to the heart which can lead to
pain and swelling as the blood is trap behind the clot. Another serious risk that can
result from blood clots is when the thrombus detaches itself from the surface where it
forms. This is known as an embolus and can have detrimental effects on a body. Once
the emboli are detached from the surface it travels through blood vessels and can
cause damage in a different location. One of the most common types is a pulmonary
embolism which occurs when the emboli passes through the heart, then into the lungs
where it has dangerous effects on the lungs as it is wedged there and prevents
sufficient blood flow. A pulmonary embolism can cause the patient to experience
difficulty in breathing, chest pain or in severe cases it can result in collapse or sudden
death.



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3.3 Ventricular Assist Devices and Blood Clots
The function of Ventricular Assist Devices (VADs) is extremely important in a
patient and therefore they need to be maintained to the highest efficiency. Blood clots
within VADs can inhibit the function, and therefore poses a serious risk in the
patients wellbeing. This risk is also increased as when VADs are used, they cause the
blood to come into contact with foreign surfaces, such as polyurethanes, and this can
start the cloth look clotting process. Also, VADs also subject the blood to flow
damaging conditions, and damage to any elements in the blood including red blood
cells, platelets or white blood cells is also a catalyst for the clotting process. Similar to
clots formed in blood vessels, the thrombi formed in VADs can also detach from the
surface and can cause serious damage in the body. Studies have shown that another
factor that can affect the formation of thrombi is the size of the VAD. Even though
adult VADs are commonly used successfully, tests on smaller VADs used in
pediatrics found that the smaller design caused a greater number of thrombi to form.
Dimensional analysis showed that there is a difference in the Reynolds and Strohal
numbers in the two VAD sizes, and it was concluded that the reduction in wall stress
and turbulence levels in the smaller VAD were the main reasons for the increase of
clotting.

As a result of the increase of this increase of blood clotting it is extremely important
that any patients that require VADs also receive anticlotting treatment. Also, another
way to ensure that extensive blood clotting does not occur is by altering the designing
the VAD, for instance one particular design called the "Heartmate", has a surface
made from fibrin and this therefore means that the patient does not require ongoing
anticlotting treatment. However, this design has a disadvantage as the surface also
increases the risk of infection.

3.4 Blood Damage
There are many different ways in which blood can be damaged when considering a
VAD. Mechanically caused damage and chemically caused damage are the two main
categories in which blood damage can be placed. Since this report is only dealing with
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the fluid mechanics aspects of blood damage, we will therefore only be emphasizing
on the mechanically caused damage.

3.5 Mechanical Causes of Damage
One main element that causes blood damage is the fluid shear stress, which can also
be affected by the laminar or turbulent flows of the blood. Also, extensive studies
have proven that the damage of blood is not only impacted by the magnitude of the
fluid shear stress but also by length of time in which is subjected to the stress. For
instance, a higher magnitude of shear stress and a longer time in which the blood is
subjected to the stress can cause lethal amounts of damage in the blood. However this
finding was only true for platelets, whereas, red blood cell damage occurs mostly
during short exposure times. Therefore it can be concluded that by designing a VAD
that does not produce high amounts of fluid shear stress, we will be contributing to the
advancement of an ideal blood pump. The fluid shear stress can be found using the
following equation.
Where:

u is the local fluid velocity.
y is the distance from the fixed surface.
is the Newtonian viscosity for laminar flow.

Also, another component that may have an effect on blood damage is the interaction
of blood and any foreign surfaces. Since VAD surfaces are foreign to the body, they
are most commonly made of polyurethane, this can cause great damage to the blood,
however why this occurs is not well understood. One way of reducing the damage
caused by the foreign surface contact is by minimizing the time of contact between
the blood and the foreign surface. Blood trauma is reduced when stagnant or
recirculated blood is removed or reducing the time. Blood clots that form in vessels
that have a higher flow rate and therefore less dangerous than those that are larger.
Therefore in VADs, a high flow rate is used remove any accumulation of platelets.
Experiments have shown that a higher shear stress significantly decreases blood
clotting on various surfaces. Another way in which clotting can be reduced is by
changing the texture of the surface, therefore minimising adhesions of the blood
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particles on it. Also, one method that can be used is by causing certain particles to
attach to the surface of the VAD thus causing a layer of endothelium. An endothelium
is a thin layer of cells that line the blood vessels, and therefore makes the VAD more
similar to an actual blood vessel, and it reduces turbulence therefore allowing the
blood to travel faster. There is however, a problem in containing the endothelium
layer to a specific thickness.

Squashing can also occur in some VAD designs and therefore can cause mechanical
damage to the blood. When valves close, blood cells and platelets may be crushed,
and this can be minimized by using different contact surfaces as a material that is less
hard would cause less blood damage.

Cavitation is another process that may cause blood damage. This process occurs when
blood travels into an area of low pressure and vapourises. These bubbles then travel
with the liquid until they reach an area of high pressure where they burst. Fluid must
then fill the area left by the collapsed bubble, and this can lead to pitting of solid
surfaces, and it may also damage the blood cells and platelets when it occurs near the
mechanical valves.

Finally when considering the blood pump, blood trauma can occur when the blood
flows through the small turbine pump because of the high shear stresses that are
developed. However, designs in blood pumps are no longer using solid bearings for
the rotor, instead hydrodynamic or electromagnetic suspension of the rotor are now
used as these only have one moving part and therefore reduce the damage on the
blood.









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4. Comparison of key aspects pertaining to blood pumps of
different designs and types
4.1 Axial Flow pump
An axial pump is crafted in such a way that it able to fit into the left ventricle of the
heart. This allows blood flows from one side of the pump from the parallel plane to
the rotation axis. Axial pumps are similar to rotary pumps and they are split into three
types of rotary; axial, diagonal and radial. From a commercial aspect, the axial pump
is regard to be the more expensive option for blood pumps. This is due to the fact that
a small electronic motor is built within the pump. However, axial flow pumps are
more reliability and efficient in their ability to pump fluid through the heart. In
addition they are miniature in size & are considered to be highly proficient.



Figure 10 - Axial Pump


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4.2 Centrifugal Pump
These pumps consist of a rotating impeller inside a rigid case. Fluid enters the pump
along the axis of rotation, the rotor imparts rotational momentum to it and the fluid
exits the pump at 90 degrees. Centrifugal pumps are being used for just short-term
ventricular assistance, and there is research being made towards a medium to long
term application. There has been some debate upon the relative merits of pulsatile and
non-pulsatile circulatory assistance, but there appears to be no difference between the
two operating regimes in short term in vivo applications.

Significantly different to the peristaltic pump is that the centrifugal pump produces a
continuous, pulseless, blood flow. Interestingly enough as stated in (Hessel et al.2003)
to date no one has conclusively demonstrated the need for pulsatile perfusion during
short-term or long-term CPB or circulatory assistance



Figure 11- Section view of centrifugal pump


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4.3 Peristaltic pump
Peristaltic pumps are relatively simple devices that is made out of PVC, silicone or
latex tubing (cannula tubing) which is compressed by two rollers 180 apart, inside a
curved raceway. As stated in (Hessel et al. 2003). Forward flow is generated by roller
compression and flow rate depends upon the diameter of the tubing, rate of rotation,
the length of the compression raceway, and completeness of compression. The wear
on the tubing is minimal and the main advantage is that the pump is physically
isolated from the blood flow, minimising infection, however small micro particles
may be shed from the tubing and so material selection is particularly important.
Peristaltic pumps are inexpensive and safe and they also prevent backward flow when
the pump is off (unlike centrifugal pumps). Peristaltic pumps have been known to
cause issues due to inappropriate selection of tubing diameter, tubing rupture causing
immediate oxygen inrush, hemolysis and backpressure



Figure 13 Section view of Peristaltic pump







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4.4 Extracorporeal Pump
These are primarily used for the medical procedures where the heart is unable to
maintain circulation, or where the heart must be shut down. In these situations the
heart-lung machine is used to perfuse the body tissue with blood. The heart-lung
machine removes blood from the left ventricular and right atrium, pumped through
the heat exchanger and then the oxygenator before being returned to the body through
plastic cannula tubes attached to the heart.




Fig 14 Cardiopulmonary bypass circuit










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4.5 Ventricular assist device (VAD)
VAD is a mechanical pump takes blood from lower chamber of heart and helps it
pump to the vital organs.VAD helps to support heart during surgery or during
transplant. A pump with magnetic bearings offers the potential of eliminating damage
and increasing design life of the pump. Flow within the pump is three-dimensional,
turbulent, and time varying (unlike most industrial pumps), yet critical because it
determines overall pump performance and potentially contributes to both red blood
cell damage and blood clotting.





Fig 15. Implantable Ventricular Assist Device






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5. Reliability
5.1 Malfunction and reliability of the Heart
Cardiovascular disease (CVD) or heart disease is Australia most costly and common
disease. Heart disease is a dangerous and complicated; the operation for it can result
in total heart failure or death.

The impact of cardiovascular disease;

During 200708, about 3.5 million Australians had a long-term cardiovascular
disease.
Nearly 50,000 deaths were attributed to CVD in Australia in 2008. CVD is
responsible for 34% of deaths in the disease group.
CVD was the main cause for 475,000 hospitalisations in 200708 and played a
secondary role in a further 797,000.
CVD remains the most expensive disease group in Australia, costing about $5.9
billion in 200405 with just over half of this money spent on patients admitted to
hospital.

In Australia, there are a number of set criteria before a CVD patient is eligible for a heart
transplant. Potential recipients must be;

Suffering of end-stage heart disease.
In good health, apart from CVD.
Likely to die without the transplant.
Able to cope with further drug treatment & required exams after the transplant.
Unable or unsuitable for different therapies.

After a person has been assessed as being suitable for a heart transplant they are put
on a waiting list. In 2011, there were only 64 transplants in Australia. With CVD
being one of the biggest killers in Australia, there needs to be a way to solve the lack
on heart donors.







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5.2 Reliability of the blood pumps
Over the years there hasnt been much success in finding an alternative to heart
transplants. Several people have died over the years due to not having an alternative
to heart transplantation (as indicated in the flow chart below). Over recent years,
scientists and engineers have worked together to try and create artificial hearts and
pumps to act as a substitute for a heart.





A German study in 2002 suggests that the use of blood pump systems is still indicated
in cases of most severe heart failure and multiorgan failure or if only short- to mid-
term circulatory support is anticipated.

Well established indications for utilization of artificial blood pumps are the bridge-to-
transplant procedure, which yields results comparable to primary heart transplantation, and
acute cardiac failure following myocardial infarction or cardiac surgical procedures.
Hearts assist system, Herz. 2002 Aug27

With advanced reliability of artificial blood pumps and in face of the high incidence
of heart failure, especially in the older age group, the long-term application of
artificial bloods pump appears to be justified.

At hird pat ient wit h chronic occlusion of t he celiac and
inferior mesent eric art eries suffered an int est inal bleed.
Colect omy wasrequired for bowel infarct ion but he even-
t ually died from mult i-organ failure. A fourt h pat ient
wit h idiopat hic-dilat ed cardiomyopat hy and no vent ricu-
lar recovery developed bivent ricular failure 12 mont hs
aft er implant at ion. Aft er improvement in renal funct ion
during 385 days of LVAD support , he was t ransplant ed
and remains well.
Two ot her pat ient s had lat e t ransient neurological
event s presumed t o be embolic in origin. This problem
was addressed by increasing t he INRt o bet ween 3.0 and
3.5 and adding aspirin 80 mg daily. One of t hese pat ient s
t hen developed a lat e S. aureus skull pedest al infect ion
which was cont rolled wit h oral ant ibiot ic t reat ment .
Alt hough ext ernal component s of t he syst em have been
exchanged in response t o wear or accident , t here has not
been any mechanical failure of t he implant able part s
during a cumulat ive support t ime in all implant ed
pat ient s of 5996 days (16.4 years).
Aut opsy st udies
All six pat ient s who died wit h t he device i n si t u had
det ailed aut opsy wit h part icipat ion of t he implant ing sur-
geons. Care was t aken t o dissect out t he pump wit h
power cables int act so t hat t he syst em could be ret urned
t o t he manufact urer for bench t est ing and durabilit y
st udies. Aft er implant t imes bet ween 3 mont hs and 3
years and even in t he absence of ant icoagulat ion
Fi gure 2 Act uarial survival of Jarvik 2000 pat ient s. The cross-mar ks depict pat ient s who are current l y on device support .
Fi gure 3 Schemat ic view of al l pat ient out comes.
Long-t erm pulseless circulat ory support 1035

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6. Key Aspects in the Comparison of Blood Pumps Versus
Water Pumps

A water pump is a device or mechanism that allows fresh water to be transported from a
low height to one that is higher and more accessible. There are many different types of
water pumps, and they can be powered by different energies, including electricity,
gasoline or windmills. Blood pumps can be compared to water pumps as the operations of
both pumps use the same principles. However when comparing these pumps, there are
aspects that must be addressed as any slight variation in a blood pump can be fatal. The
five areas include;

Efficiency
Shear-stress levels (hemolysis)
Stagnation and blood clotting (thrombus)
Blood turbulence (hemolysis)
Cavitation (formation of air bubbles)
6.1 Efficiency
The efficiency of blood pumps is extremely important, as any error can be critical in a
patient. In comparison the efficiency of a water pump is less important. The level of
efficiency of water pumps is usually only required to satisfy the application of the
pump, and the main or generator power. Blood pumps, however must be more
adapted to the human body and its activities. Ideally, a blood pump would require
minimal power, and be able to operate of a longer period of time without being
connected to a power source, or requiring many rechargeable batteries. In order for a
blood pump to be efficient, it must be compact enough to allow the patient to live a
relatively normal life. By increasing the efficiency of a blood pump, the overall
wellbeing of the patient would be maintained, and therefore the pump can be used as a
permanent or temporary remedy. The reliability of the blood pump is extremely
important as it acts as a substitute for the heart. Currently there are no perfect
substitutes for the heart as most artificial heart (blood pumps) fail within a few years
of being placed within the patients body. Research into making blood pumps
efficient is extremely important as when an ideal blood pump is designed a patient
21


who may die waiting for a heart transplant will be able to live a normal life, without
needing to regularly replace components of their pump, and still waiting on the
transplant list. The article Exercise capacity in patients supported with rotary blood
pumps is improved by a spontaneous increase of pump flow at constant pump speed
and by a rise in native cardiac output. Allows the reader to see how a patients life
can be improved when a blood pump is more efficient as the patients where able to
exercise, and therefore allowing them enjoy more freedom in their life.
6.2 Shear Stress
Also, when comparing water and blood pumps, the shear stress caused by the
stationary walls of the pump on the liquid, is another critical component that must be
examined. The blood that passes through the solid walls of the pump and veins will
experience shear stresses due to the friction between the two surfaces. Blood pumps
are made up of tubes, valves and housings, which increase the friction, and therefore
produce a significant amount of shear stresses in the blood. High levels of shear stress
in the blood can cause blood damage, including platelet and white cell damage, and
therefore must be minimised in order to ensure the blood pump is beneficial to the
patient. The high shear stresses exerted on the blood can result in a condition called
hemolysis. One way to minimise these stresses is by decreasing the blood acceleration
through the pump and thus ensuring a settled and undisrupted flow.

6.3 Stagnation and Blood Clotting
When any foreign object is inserted into the human body, it is extremely important to
ensure homeostasis is maintained. A blood pump can disrupt the flow of blood in a
patients body and therefore the pump must ensure that the flow of blood is
maintained without causing any excessive instability. Any turbulence in the blood
flow can result in stagnation of the blood and this can increase the risk of blood
clotting and a result thrombus may occur. Thrombus is a condition which may be fatal
in a patient, and therefore the risk of it must be reduced and this is done by examining
the artificial hearts for any areas of low flow, as these areas have the greatest risk of
stagnation.
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6. 4 Blood Turbulence
In a blood pump, when the blood flow is turbulent, the flow rate decreases and there
is also an increase in the loss of energy in the form of friction and this causes higher
shear stress levels in the blood, causing blood damage. Therefore it is extremely
important to ensure that the blood flow in a pump remains laminar, and this can be
achieved by changing the velocity or path of the blood flow. As can be seen in the
diagram below, an unobstructed flow path is more desirous in a blood pump as it
produces a laminar blood flow.

Also, the blood flow can be determined by examining the Reynolds number for blood
flow. When there is a higher Reynolds number, there is an increase of the chances of
turbulence in the flow. A lower Reynolds number can be achieved by decreasing the
velocity of the blood, the diameter of the tubes and the density, and by increasing the
viscosity of the fluid.
6.5 Cavitation
Cavitation in a blood pump occurs when a negative (or near zero) pressure is
developed by the pump. This pressure drop can cause air bubbles to form, and these
air bubbles may enter the blood flow, or can also cause blood clots. When cavitation
occurs in a blood pump, the consequence may be detrimental, as the air bubbles may
block blood flow through the capillaries, and can cause great harm to the patient and
therefore it is extremely important that this issue be addressed. Even though cavitation
does occur in water pumps, and it also does not produce desired consequences, the
magnitude of it in water pumps is a lot less than that of the blood pumps.


7. The issues that are dealt with Blood pumps and direction to
their solution
Blood Pumps need to imitate the human heart as closely as possible. A certain
difference in fluid flow behaviour can have detrimental effects to both the fluid (blood)
and body itself. This technology has been advancing in design and performance since the
23


Figure a.a Large and mainly inefficient
power supply for artificial hearts
1970s. However to this day, mechanical blood pumps remain unsuitable to perfectly
replace the heart as many issues and problems are involved. Power supply, Blood flow
rate& Pressure output, Biocompatibility, and Size are the key issues that are constantly
challenged for an improved pump design.
7.1 Power Supply
All artificial hearts are powered by batteries. Power output is carefully set and
monitored such that it is sufficient enough to fuel both the motor and will have
minimal effects on the body.
Since there is a limited source of battery life, a rechargeable battery of reasonable size
is implanted inside the abdomen. Linked to this battery are a small electronic heart
controller and a wireless energy transfer link. The rechargeable battery is fuelled
through electromagnetic induction from a large
external battery pack that constantly needs to be
carried around the waist. This power source can
last up to 5 hours before the external battery itself
requires change. In the case of a failure to charge,
the implanted battery acts as an emergency battery
which to this day lasts only 45minutes, which is
enough to provide the ability to seek assistance.
The lifespan and size of both internal and external
batteries are constantly being researched to be able
to last longer yet also decrease in physical size for
the patients comfort and convenience.

7.2 Flow rate & Pressure
Blood flow rate behaviour and pressure inside the blood pump are the core issues
which are always considered in the design of a new blood pump. Pressure too high
relative to average human heart pressure output can exceed the pressure tolerance of
red blood cell walls, causing a tear in its structure. An excessive amount of destroyed
or damaged blood cells lead to haemolytic anaemia which is hazardous in the human
body. On the other hand, pressure that is too low deprives regions of the body from
blood flow due to lack of force. This leads to the potential development of blood
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clotting inside vessels also known as thrombosis (as discussed in 6.2). Both levels of
pressure result in a form of blood damage where large quantity can cause death.
An average human heart pumps through 1600km of blood vessels and can pump from
5litres to 15litres of blood per minute. Current devices are restricted at 10litres per
minute and are disconnected from the nervous system. This limits the patients ability
to engage in vigorous physical activities since the machine will not be synchronised
with the bodys requirements.
7.2.1 Solution
A series of complex calculation derived from experiments and observations is used to
set the operating speed of the motor pump. Internal flow rate and pressure sensors are
used to find the appropriate settings for the flow rate required which then controls the
operational speed of the heart pump. In Systems such as axial pumps (Continuous
flow) there is not much variation in speed and the pressure they create is nearer to
the systolic pressure than the diastolic pressure.

7.3 Biocompatibility
Blood pumps, being unnatural, are easily rejected by the body as it is considered a
foreign object. Due to the bulkiness and lack of soft, compressible tissue like the
heart, blood pumps can exert pressure on the organs around it. There is a large risk of
contamination and bacterial infection from the material that it is made of. Rough or
uneven wall surfaces will create friction and act as a damaged blood vessel hence will
attract platelets to collect in the pump and clot, affecting the performance of the heart
pump and the resultant blood flow behaviour.
7.3.1 Solution
To avoid the bodys rejection of foreign objects, the blood pumps are built efficiently
and tailored to variable size such that it is able to fit inside the patients body without
causing internal damage. Pumps need to be composed of lifelong durable materials
that are chemically unreactive and sterilised. This is required to ensure little or no
particle contamination in the blood stream can occur. To reduce blood clotting and
damage it is necessary for the materials to be extremely smooth. Of specific concern
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is the process of blood clotting as its effects can be sensed somewhere else in the
body. Patients also take anti-coagulating medication to avoid or reduce blood clotting.

8. How fluid mechanics has been applied to help solve
problems and issues associated with blood pumps
Fluid mechanics is used to study the behavior of various fluids in a given environment.
Computer analysis, experiments and simulations have been used to replicate flow patterns
and point out where blood is subjected to higher pressure, stresses and friction. The
characteristics of blood are not Newtonian, so conventional fluid behavior such as water
cannot be simply used to replicate blood. However blood can be assumed to act
Newtonian when the Reynolds number is high since large arteries carry high flow rate.

The mechanical valves in the heart pump are areas where blood damage easily occurs
from the high pressure exerted by the rotor and clotting from friction of the heart walls.
Fluid mechanics explain as to why this issue occurs and the complications of mechanical
heart valves. An ideal pump would have minimum pressure drops, turbulence, backwash
and low shear stress. This aspect of pump design was implemented from the study of
water flow rate through pipes. Knowledge of fluid mechanics is applied to measure the
effective orifice area (EOA) of a valve, as well as the pressure drop inside. Use the
effective orifice area equation and energy equation, a higher EOA corresponds to lower
energy loss (see appendix).The energy equation calculates any energy losses within the
heart pump and aim to improve pumping efficiency.
Other issues related to blood damage such a Hemolysis and Thrombosis are analysed
from devices used to measure shear stress and models of blood flow. However this
technology is limited to measure blood activities at certain points.
Despite the incomplete understanding of blood flow its characteristics, fluid
mechanics provide the foundation to a more accurate physical design of the heart pump
where it will act more like a human heart and reduce or avoid areas of turbulence and
extreme acceleration.



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Appendix
The equation below outlines the effective orifice area and the energy equation where q=


Effective orifice area:


Energy Equation:











http://www.ncbi.nlm.nih.gov/pubmed/14653417

http://www.hematology.org/Patients/Blood-Disorders/Blood-Clots/5233.aspx