Three-Dimensional Fluid-Structure Interaction Reveals Trade-offs Among Oxygen Delivery, Shear, and Washout in Pediatric Roller-Pump Cardiopulmonary Bypass

Objective: To determine how roller speed, tubing occlusion, and hematocrit jointly regulate oxygen delivery, shear, and washout in pediatric roller-pump cardiopulmonary bypass. Methods: A three-dimensional, closed-loop fluid-structure interaction model resolved roller-tube contact, tubing deformation, and blood flow. Forty simulations combined 4 roller speeds (38-95 revolutions per minute), 2 occlusion levels (77% and 83%), and 5 hematocrit levels (15%-50%). Cycle-averaged flow, oxygen delivery, peak shear stress, and viscosity-normalized relative residence time were quantified. Results: Roller compression produced retrograde leakage through the occluded gap, localized peak shear stress exceeding 100 pascals, and adjacent stagnation and recirculation. Flow increased nearly linearly with roller speed and was higher at greater occlusion, with little hematocrit dependence. Higher speed and occlusion increased peak shear stress while reducing relative residence time; higher hematocrit further increased peak shear stress. Similar oxygen delivery could arise from substantially different flow environments: among 10 conditions providing oxygen delivery of approximately 9-12 milliliters per minute, peak shear stress ranged from approximately 25 to 70 pascals. Within conditions satisfying an illustrative minimum oxygen-delivery threshold, lower hematocrit permitted speed and occlusion settings yielding lower peak shear stress and relative residence time. Conclusions: Pediatric roller-pump settings that provide similar oxygen delivery can expose blood to markedly different shear and washout environments. Joint evaluation of these metrics may guide selection of speed, occlusion, and hematocrit to meet a target oxygen delivery while reducing shear and improving washout. Keywords: Cardiopulmonary bypass; roller pump; pediatric cardiac surgery; fluid-structure interaction; shear stress; relative residence time