Abstract
Rotary blood pumps (RBPs) are increasingly used as left ventricular assist devices (LVADs) to treat patients with advanced heart failure. In clinical practice, RBPs are fixed speed controlled which causes an insufficient adaption of the pump flow to the varying blood flow demand of the patient. This can lead to undesired or even dangerous operating conditions and impedes patients leading a normal life with an LVAD. This paper presents a robust nonpulsatile control strategy that amplifies the remaining native physiological control loops that affect the total cardiac output (CO). The setting option of this control strategy is called Assistance, which is defined as the time-averaged ratio of pump flow and total CO. By keeping the Assistance at a constant level, the cardiac workload is shared between the native heart and the LVAD, even when the blood flow demand is changing. The control strategy was implemented on a real-time computer operating a transvalvular LVAD. The Assistance is determined using estimations of the pump flow and the aortic flow rate. The latter is estimated with an extended Kalman filter based on pressure measurements provided by optical pressure sensors mounted on the pump inlet and outlet. Proof-of-concept was established in hybrid mock circulatory loop trials, in which stable Assistances ranging from 20 % to 77.5 % were achieved. In case the native CO control loops are still intact, the Assistance control strategy adequately maintains the systemic circulation and offers an intuitive setting option for the treating physician.
Preview
Unable to display preview. Download preview PDF.
References
Kirklin J K, Naftel D C, Pagani F D, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:1495–1504.
Slaughter M S, Pagani F D, Rogers J G, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure J Heart Lung Transplant. 2010;29:S1–S39.
AlOmari A-H, Savkin A V, Stevens M, et al. Developments in control systems for rotary left ventricular assist devices for heart failure patients: a review Physiol Meas. 2013;34:R1–R27.
Bozkurt S. Physiologic outcome of varying speed rotary blood pump support algorithms: a review study Australas Phys Eng Sci Med. 2016;39:13–28.
Young D. Control of Cardiac Output. Morgan & Claypool 2010.
Colacino F M, Moscato F, Piedimonte F, Arabia M, Danieli G A. Left ventricle load impedance control by apical VAD can help heart recovery and patient perfusion: a numerical study ASAIO J. 2007;53:263–277.
Al-Rashid F, Nix C, Erbel R, Kahlert P. Tools & Techniques - clinical: percutaneous catheter-based left ventricular support using the Impella CP EuroIntervention. 2014;10:1247–1249.
Abeysinghe D C, Dasgupta S, Boyd J T, Jackson H E. A novel MEMS pressure sensor fabricated on an optical fiber IEEE Photonics Technology Letters. 2001;13:993–995.
Abiomed, Inc.. Impella CP - Instructions for use & clinical reference manual 2015.
RĂ¼schen D, Rimke M, Gesenhues J, Leonhardt S, Walter M. Online cardiac output estimation during transvalvular left ventricular assistance Comput Methods Programs Biomed. 2016. [Epub aop].
Skogestad S, Postlethwaite I. Multivariable feedback control: analysis and design;2. John Wiley & Sons 2005.
Misgeld B, RĂ¼schen D, Schwandtner S, Heinke S, Walter M, Leonhardt S. Robust decentralised control of a hydrodynamic human circulatory system simulator Biomed Signal Process Control. 2015;20:35–44.
Heinke S, Pereira C, Leonhardt S, Walter M. Modeling a healthy and a person with heart failure conditions using the object-oriented modeling environment Dymola Medical & Biological Engineering & Computing. 2015;53:1049–1068.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Singapore Pte Ltd.
About this paper
Cite this paper
RĂ¼schen, D., Opitz, S., Korn, L., Leonhardt, S., Walter, M. (2018). Robust Assistance Control of Left Ventricular Assist Devices. In: Eskola, H., Väisänen, O., Viik, J., Hyttinen, J. (eds) EMBEC & NBC 2017. EMBEC NBC 2017 2017. IFMBE Proceedings, vol 65. Springer, Singapore. https://doi.org/10.1007/978-981-10-5122-7_74
Download citation
DOI: https://doi.org/10.1007/978-981-10-5122-7_74
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-5121-0
Online ISBN: 978-981-10-5122-7
eBook Packages: EngineeringEngineering (R0)