In-silico Hemodynamics Simulations to Investigate Stroke Outcomes in Patients After Left Ventricular Assist Device Implantation*

Stroke is a leading cause of complications and death in advanced heart failure patients treated with implanted Left Ventricular Assist Device (LVAD). Hemodynamics significantly determines stroke risk in patients on LVAD support. However, quantitative assessment of flow variables and their relation to stroke outcomes post-LVAD implantation remains a major challenge. This inspired our in-silico study comprising patient-specific hemodynamics analyses in a set of 12 patients on LVAD support: 6 with reported stroke outcomes and 6 without. We compared hemodynamics using quantitative flow descriptors for helicity, vortex generation, and wall shear stress. Baseline flow pre-implantation was studied to analyze hemodynamic alterations from a pre-implant flow scenario that can potentially reveal hidden links to stroke outcomes during LVAD support. Finally, we analyzed differences in a Lagrangian particle transport analysis for embolism potential. Our analysis revealed key differences in flow descriptors, their ratios against baseline pre-implant flow, and Lagrangian descriptors, between the cases with and without stroke outcomes. Building upon these observations in future works can lead to significant advancements in understanding stroke etiology and pre-surgical assessment of stroke risks.