From Early Models to Emerging Trends: The Evolution of Computational Hemolysis Prediction.

Mechanical hemolysis remains one of the most critical complications associated with blood-contacting devices. Computational prediction of blood damage has been widely adopted as a key tool for evaluating the hemolytic potential of cardiovascular devices. Although numerical hemolysis modeling has been investigated since the 1990s, a universally accurate and predictive approach is still lacking. This review traces the evolution of computational hemolysis models, from the earliest stress-based power-law formulation to recent strain-based approaches that describe the red blood cells at cellular and molecular levels. It examines the various definitions of the power-law shear stress found in literature, including Von Mises-like formulations, extensions incorporating extensional or Reynolds stresses and those based on turbulent dissipation rate or deformation of the red blood cell. The broad range of power-law constants reported in literature is summarized, together with their development conditions. Furthermore, the Lagrangian and Eulerian approaches used for numerical hemolysis predictions are analyzed in detail. Finally, emerging trends and future directions are highlighted, offering insights into the pathways toward more reliable hemolysis modeling.