Abstract
The low preload and high afterload sensitivities of rotary ventricular assist devices (VADs) may cause ventricular suction events or venous congestion. This is particularly problematic with rotary biventricular support (BiVAD), where the Starling response is diminished in both ventricles. Therefore, VADs may benefit from physiological control systems to prevent adverse events. This study compares active, passive and combined physiological controllers for rotary BiVAD support with constant speed mode. Systemic (SVR) and pulmonary (PVR) vascular resistance changes and exercise were simulated in a mock circulation loop to evaluate the capacity of each controller to prevent suction and congestion and increase exercise capacity. All controllers prevented suction and congestion at high levels of PVR (900 dynes s cm−5) and SVR (3000 dynes s cm−5), however these events occurred in constant speed mode. The controllers increased preload sensitivity (0.198–0.34 L min−1 mmHg−1) and reduced afterload sensitivity (0.0001–0.008 L min−1 mmHg−1) of the VADs when compared to constant speed mode (0.091 and 0.072 L min−1 mmHg−1 respectively). The active controller increased pump speeds (400–800 rpm) and pump flow by 2.8 L min−1 during exercise, thus increasing exercise capacity. By reducing suction and congestion and by increasing exercise capacity, the control systems presented in this study may help increase quality of life of VAD patients.
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Aissaoui, N., M. Morshuis, M. Schoenbrodt, K. Hakim Meibodi, L. Kizner, J. Börgermann, and J. Gummert. Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients. J. Thorac. Cardiovasc. Surg. 146:186–191, 2013.
Alomari, A. H., A. V. Savkin, P. J. Ayre, E. Lim, and N. H. Lovell. Sensorless estimation of inlet pressure in implantable rotary blood pump for heart failure patients. Electron. Lett. 46:481–483, 2010.
AlOmari, A.-H. H., A. V. Savkin, M. Stevens, D. G. Mason, D. L. Timms, R. F. Salamonsen, and N. H. Lovell. Developments in control systems for rotary left ventricular assist devices for heart failure patients: a review. Physiol. Meas. 34:R1–R27, 2013.
Choi, S., J. E. Antaki, R. Boston, and D. Thomas. A sensorless approach to control of a turbodynamic left ventricular assist system. IEEE Trans. Control Syst. Technol. 9:473–482, 2001.
Epstein, S. E., G. D. Beiser, M. Stampfer, B. F. Robinson, and E. Braunwald. Characterization of the circulatory response to maximal upright exercise in normal subjects and patients with heart disease. Circulation 35:1049–1062, 1967.
Ferreira, A., J. R. Boston, and J. F. Antaki. A control system for rotary blood pumps based on suction detection. IEEE Trans. Biomed. Eng. 56:656–665, 2009.
Gaddum, N. R., D. L. Timms, and M. J. Pearcy. Optimizing the response from a passively controlled biventricular assist device. Artif. Organs 34:393–401, 2010.
Gaddum, N. R., D. L. Timms, M. Stevens, D. Mason, N. Lovell, and J. F. Fraser. Comparison of preload-sensitive pressure and flow controller strategies for a dual device biventricular support system. Artif. Organs 36:256–265, 2012.
Granegger, M., F. Moscato, F. Casas, G. Wieselthaler, and H. Schima. Development of a pump flow estimator for rotary blood pumps to enhance monitoring of ventricular function. Artif. Organs 36:691–699, 2012.
Gregory, S.D., M. Stevens, D. Timms, M. Pearcy (2011) Replication of the Frank-Starling response in a mock circulation loop. In: Conf. Proc. IEEE Eng. Med. Biol. Soc., 2011, pp. 6825–6828.
Gregory, S. D., M. J. Pearcy, and D. Timms. Passive control of a biventricular assist device with compliant inflow cannulae. Artif. Organs 36:683–690, 2012.
Gregory, S., E. Schummy, and J. Pauls. A compliant banded outflow cannula for decreased afterload sensitivity of rotary right ventricular assist devices. Artif. Organs 39:102–109, 2014.
Guazzi, M., and B. A. Borlaug. Pulmonary hypertension due to left heart disease. Circulation 126:975–990, 2012.
Hetzer, R., T. Krabatsch, A. Stepanenko, E. Hennig, and E. V. Potapov. Long-term biventricular support with the heartware implantable continuous flow pump. J. Heart Lung Transplant. 29:822–824, 2010.
Kirklin, J., D. Naftel, R. Kormos, L. Stevenson, F. Pagani, and M. Miller. Second INTERMACS annual report: more than 1000 primary left ventricular assist devices implants. J. Heart Lung Transplant. 29:1–10, 2010.
Klabunde, R. E. Cardiovascular Physiology Concepts. Baltimore: Lippincott Williams & Wilkins, 2010.
Korakianitis, T., and Y. Shi. Numerical comparison of hemodynamics with atrium to aorta and ventricular apex to aorta VAD support. ASAIO J. 53:537–548, 2007.
Lampert, B. C., C. Eckert, S. Weaver, A. Scanlon, K. Lockard, C. Allen, N. Kunz, C. Bermudez, J. K. Bhama, M. A. Shullo, R. L. Kormos, M. A. Dew, and J. J. Teuteberg. Blood pressure control in continuous flow left ventricular assist devices: efficacy and impact on adverse events. Ann. Thorac. Surg. 97:139–146, 2014.
McClean, D., J. Aragon, A. Jamali, S. Kar, J. Ritzema-Carter, R. Troughton, H. Krum, R. Doughty, W. T. Abraham, J. S. Whiting, and N. Eigler. Noninvasive calibration of cardiac pressure transducers in patients with heart failure: an aid to implantable hemodynamic monitoring and therapeutic guidance. J. Card. Fail. 12:568–576, 2006.
Noon, G. P., D. L. Morley, S. Irwin, S. V. Abdelsayed, R. J. Benkowski, and B. E. Lynch. Clinical experience with the MicroMed DeBakey ventricular assist device. Ann. Thorac. Surg. 71:S133–S138, 2001.
Reesink, K., A. Dekker, T. Van der Nagel, C. Beghi, F. Leonardi, P. Botti, Cicco G. De, R. Lorusso, F. Van der Veen, and J. Maessen. Suction due to left ventricular assist: implications for device control and management. Artif. Organs 31:542–549, 2007.
Salamonsen, R. F., D. G. Mason, and P. J. Ayre. Response of rotary blood pumps to changes in preload and afterload at a fixed speed setting are unphysiological when compared with the natural heart. Artif. Organs 35:E47–E53, 2011.
Salamonsen, R. F., V. Pellegrino, J. F. Fraser, K. Hayes, D. Timms, N. H. Lovell, and C. Hayward. Exercise studies in patients with rotary blood pumps: cause, effects, and implications for starling-like control of changes in pump flow. Artif. Organs 37:695–703, 2013.
Santambrogio, L., T. Bianchi, M. Fuardo, F. Gazzoli, A. Braschi, M. Maurelli, and R. Veronesi. Right ventricular failure after left ventricular assist device insertion: preoperative risk factors. Interact. Cardiovasc. Thorac. Surg. 5:379–382, 2006.
Slaughter, M. S., F. D. Pagani, J. G. Rogers, L. W. Miller, B. Sun, S. D. Russell, R. C. Starling, L. Chen, A. J. Boyle, S. Chillcott, R. M. Adamson, M. S. Blood, M. T. Camacho, K. A. Idrissi, M. Petty, M. Sobieski, S. Wright, T. J. Myers, and D. J. Farrar. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J. Heart Lung Transplant. 29:S1–S39, 2010.
Stevens, M. C., S. Wilson, A. Bradley, J. Fraser, and D. Timms. Physiological control of dual rotary pumps as a biventricular assist device using a master/slave approach. Artif. Organs 38:766–774, 2014.
Strueber, M., A. L. Meyer, D. Malehsa, and A. Haverich. Successful use of the HeartWare HVAD rotary blood pump for biventricular support. J. Thorac. Cardiovasc. Surg. 140:936–937, 2010.
Tansley, G., S. Vidakovic, and J. Reizes. Fluid dynamic characteristics of the VentrAssist rotary blood pump. Artif. Organs 24:483–487, 2000.
Timms, D. L., S. D. Gregory, N. A. Greatrex, M. J. Pearcy, J. F. Fraser, and U. Steinseifer. A compact mock circulation loop for the in vitro testing of cardiovascular devices. Artif. Organs 35:384–391, 2011.
Troughton, R. W., J. Ritzema, N. L. Eigler, I. C. Melton, H. Krum, P. B. Adamson, S. Kar, P. K. Shah, J. S. Whiting, J. T. Heywood, S. Rosero, J. P. Singh, L. Saxon, R. Matthews, I. G. Crozier, and W. T. Abraham. Direct left atrial pressure monitoring in severe heart failure: long-term sensor performance. J. Cardiovasc. Transl. Res. 4:3–13, 2011.
Vollkron, M., H. Schima, L. Huber, R. Benkowski, G. Morello, and G. Wieselthaler. Development of a suction detection system for axial blood pumps. Artif. Organs 28:709–716, 2004.
Vollkron, M., P. Voitl, J. Ta, G. Wieselthaler, and H. Schima. Suction events during left ventricular support and ventricular arrhythmias. J. Heart Lung Transplant. 26:819–825, 2007.
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The authors would like to recognize the financial assistance provided by The Prince Charles Hospital Foundation (MS2012-34 and NR2013-222), Griffith University and University of Queensland.
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Associate Editor Jane Grande-Allen oversaw the review of this article.
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Pauls, J.P., Stevens, M.C., Schummy, E. et al. In Vitro Comparison of Active and Passive Physiological Control Systems for Biventricular Assist Devices. Ann Biomed Eng 44, 1370–1380 (2016). https://doi.org/10.1007/s10439-015-1425-1
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DOI: https://doi.org/10.1007/s10439-015-1425-1