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Biomedical Engineering / Biomedizinische Technik

Joint Journal of the German Society for Biomedical Engineering in VDE and the Austrian and Swiss Societies for Biomedical Engineering and the German Society of Biomaterials

Editor-in-Chief: Dössel, Olaf

Editorial Board: Augat, Peter / Haueisen, Jens / Jockenhoevel, Stefan / Knaup-Gregori, Petra / Lenarz, Thomas / Leonhardt, Steffen / Plank, Gernot / Radermacher, Klaus M. / Schkommodau, Erik / Stieglitz, Thomas / Boenick, Ulrich / Jaramaz, Branislav / Kraft, Marc / Lenthe, Harry / Lo, Benny / Mainardi, Luca / Micera, Silvestro / Penzel, Thomas / Robitzki, Andrea A. / Schaeffter, Tobias / Snedeker, Jess G. / Sörnmo, Leif / Sugano, Nobuhiko / Werner, Jürgen /

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Volume 62, Issue 2 (Apr 2017)

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Volume 57 (2012)

High-frequency operation of a pulsatile VAD – a simulation study

Mathias Rebholz
  • pd|z Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Raffael Amacher / Anastasios Petrou
  • pd|z Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
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  • De Gruyter OnlineGoogle Scholar
/ Mirko Meboldt
  • pd|z Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
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  • De Gruyter OnlineGoogle Scholar
/ Marianne Schmid Daners
  • Corresponding author
  • pd|z Product Development Group Zurich, CLA G21.1 Tannenstr. 3, 8092 Zurich, Switzerland, Phone: +41 44 632 2447
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  • Other articles by this author:
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Published Online: 2016-08-09 | DOI: https://doi.org/10.1515/bmt-2016-0052

Abstract

Ventricular assist devices (VADs) are mechanical blood pumps that are clinically used to treat severe heart failure. Pulsatile VADs (pVADs) were initially used, but are today in most cases replaced by turbodynamic VADs (tVADs). The major concern with the pVADs is their size, which prohibits full pump body implantation for a majority of patients. A reduction of the necessary stroke volume can be achieved by increasing the stroke frequency, while maintaining the same level of support capability. This reduction in stroke volume in turn offers the possibility to reduce the pump’s overall dimensions. We simulated a human cardiovascular system (CVS) supported by a pVAD with three different stroke rates that were equal, two- or threefold the heart rate (HR). The pVAD was additionally synchronized to the HR for better control over the hemodynamics and the ventricular unloading. The simulation results with a HR of 90 bpm showed that a pVAD stroke volume can be reduced by 71%, while maintaining an aortic pulse pressure (PP) of 30 mm Hg, avoiding suction events, reducing the ventricular stroke work (SW) and allowing the aortic valve to open. A reduction by 67% offers the additional possibility to tune the interaction between the pVAD and the CVS. These findings allow a major reduction of the pVAD’s body size, while allowing the physician to tune the pVAD according to the patient’s needs.

Keywords: hemodynamics with mechanical circulatory support; pulsatile blood pumps; pulsatility; synchronous operation, ventricular assist device (VAD)

References

  • [1]

    Amacher R, Ochsner G, Schmid Daners M. Synchronized pulsatile speed control of turbodynamic left ventricular assist devices: review and prospects. Artif Organs 2014; 38: 867–875.Google Scholar

  • [2]

    Amacher R, Weber A, Brinks H, et al. Control of ventricular unloading using an electrocardiogram-synchronized Thoratec paracorporeal ventricular assist device. J Thorac Cardiovasc Surg 2013; 146: 710–717.Google Scholar

  • [3]

    Ando M, Nishimura T, Takewa Y, et al. Electrocardiogram-synchronized rotational speed change mode in rotary pumps could improve pulsatility. Artif Organs 2011; 35: 941–947.Google Scholar

  • [4]

    Ando M, Takewa Y, Nishimura T, et al. A novel counterpulsation mode of rotary left ventricular assist devices can enhance myocardial perfusion. J Artif Organs 2011; 14: 185–191.Google Scholar

  • [5]

    Bourque K, Dague C, Farrar D, et al. In vivo assessment of a rotary left ventricular assist device-induced artificial pulse in the proximal and distal aorta. Artif Organs 2006; 30: 638–642.Google Scholar

  • [6]

    Colacino FM, Moscato F, Piedimonte F, Arabia M, Danieli GA. Left ventricle load impedance control by apical VAD can help heart recovery and patient perfusion: a numerical study. ASAIO J 2007; 53: 263–277.Google Scholar

  • [7]

    Crow S, John R, Boyle A, et al. Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices. J Thorac Cardiovasc Surg 2009; 137: 208–215.Google Scholar

  • [8]

    Drews T, Jurmann M, Michael D, Miralem P, Weng Y, Hetzer R. Differences in pulsatile and non-pulsatile mechanical circulatory support in long-term use. J Heart Lung Transpl 2008; 27: 1096–1101.Google Scholar

  • [9]

    Farrar DJ, Bourque K, Dague CP, Cotter CJ, Poirier VL. Design features, developmental status, and experimental results with the heartmate III centrifugal left ventricular assist system with a magnetically levitated rotor. ASAIO J 2007; 53: 310–315.Google Scholar

  • [10]

    Garcia S, Kandar F, Boyle A, et al. Effects of pulsatile- and continuous-flow left ventricular assist devices on left ventricular unloading. J Heart Lung Transpl 2008; 27: 261–267.Google Scholar

  • [11]

    Gazzoli F, Vigano M, Pagani F, et al. Initial results of clinical trial with a new left ventricular assist device (LVAD) providing synchronous pulsatile flow. Int J Artif Organs 2009; 32: 334–353.Google Scholar

  • [12]

    Granegger M, Moscato F, Casas F, Wieselthaler G, Schima H. Development of a pump flow estimator for rotary blood pumps to enhance monitoring of ventricular function. Artif Organs 2012; 36: 691–699.Google Scholar

  • [13]

    Guyton AC, Hall JE. Textbook of medical physiology. 12th ed. Philadelphia: Saunders, 2010.Google Scholar

  • [14]

    Heredero A, Perez-Caballero R, Otero J, et al. Synchrony relationships between the left ventricle and a left ventricular assist device: an experimental study in pigs. Int J Artif Organs 2012; 35: 272–278.Google Scholar

  • [15]

    Imamura T, Kinugawa K, Nitta D, et al. Advantage of pulsatility in left ventricular reverse remodeling and aortic insufficiency prevention during left ventricular assist device treatment. Circ J 2015; 79: 1994–1999.Google Scholar

  • [16]

    Ising M, Warren S, Sobieski MA, Slaughter MS, Koenig SC, Giridharan GA. Flow modulation algorithms for continuous flow left ventricular assist devices to increase vascular pulsatility: a computer simulation study. Cardiovasc Eng Technol 2011; 2: 90–100.Google Scholar

  • [17]

    John R, Lee S, Eckman P, Liao K. Right ventricular failure – a continuing problem in patients with left ventricular assist device support. J Cardiovasc Transl Res 2010; 3: 604–611.Google Scholar

  • [18]

    Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transpl 2015; 34: 1495–1504.Google Scholar

  • [19]

    Klotz S, Deng MC, Stypmann J, et al. Left ventricular pressure and volume unloading during pulsatile versus nonpulsatile left ventricular assist device support. Ann Thorac Surg 2004; 77: 143–150.Google Scholar

  • [20]

    Krabatsch T, Schweiger M, Dandel M, et al. Is Bridge to recovery more likely with pulsatile left ventricular assist devices than with nonpulsatile-flow systems? Ann Thorac Surg 2011; 91: 1335–1340.Google Scholar

  • [21]

    Lim E, Salamonsen RF, Mansouri M, et al. Hemodynamic response to exercise and head-up tilt of patients implanted with a rotary blood pump: a computational modeling study. Artif Organs 2015; 39: E24–E35.Google Scholar

  • [22]

    May-Newman K, Enriquez-Almaguer L, Posuwattanakul P, Dembitsky W. Biomechanics of the aortic valve in the continuous flow VAD-assisted heart. ASAIO J 2010; 56: 301–308.Google Scholar

  • [23]

    Moazami N, Dembitsky WP, Adamson R, et al. Does pulsatility matter in the era of continuous-flow blood pumps? J Heart Lung Transplant 2015; 34: 999–1004.Google Scholar

  • [24]

    Nakamura T, Hayashi K, Seki J, et al. Effect of drive mode of left ventricular assist device on the left ventricular mechanics. Artif Organs 1988; 12: 56–66.Google Scholar

  • [25]

    Ochsner G, Amacher R, Schmid Daners M. Emulation of ventricular suction in a hybrid mock circulation, in Proc. 2013 European Control Conference, 2013, 3108–3112.Google Scholar

  • [26]

    Pirbodaghi T, Axiak S, Weber A, Gempp T, Vandenberghe S. Pulsatile control of rotary blood pumps: Does the modulation waveform matter? J Thorac Cardiovasc Surg 2012; 144: 970–977.Google Scholar

  • [27]

    Pirbodaghi T, Weber A, Carrel T, Vandenberghe S. Effect of pulsatility on the mathematical modeling of rotary blood pumps. Artif Organs 2011; 35: 825–832.Google Scholar

  • [28]

    Schima H, Dimitrov K, Zimpfer D. Debate: creating adequate pulse with a continuous flow ventricular assist device: can it be done and should it be done? Probably not, it may cause more problems than benefits! Curr Opin Cardiol 2016; 31: 337–342.Google Scholar

  • [29]

    Schumer EM, Black MC, Monreal G, Slaughter MS. Left ventricular assist devices: current controversies and future directions. Eur Heart J 2015; 590–597.Google Scholar

  • [30]

    Soucy KG, Koenig SC, Giridharan GA, Sobieski MA, Slaughter MS. Rotary pumps and diminished pulsatility: do we need a pulse? ASAIO J 2013; 59: 355–366.Google Scholar

  • [31]

    Stewart GC, Mehra MR. A history of devices as an alternative to heart transplantation. Heart Fail Clin 2014; 10: S1–S12.Google Scholar

  • [32]

    Timms D. A review of clinical ventricular assist devices. Med Eng Phys 2011; 33: 1041–1047.Google Scholar

  • [33]

    Umeki A, Nishimura T, Takewa Y, et al. Change in myocardial oxygen consumption employing continuous-flow LVAD with cardiac beat synchronizing system, in acute ischemic heart failure models. J Artif Organs 2013; 16: 119–128.Google Scholar

  • [34]

    Vandenberghe S, Nishida T, Segers P, Meyns B, Verdonck P. The impact of pump speed and inlet cannulation site on left ventricular unloading with a rotary blood pump. Artif Organs 2004; 28: 660–667.Google Scholar

  • [35]

    Yozu R, Golding L, Yada I, et al. Do we really need pulse? Chronic nonpulsatile and pulsatile blood flow: from the exercise response viewpoints. Artif Organs 1994; 18: 638–642.Google Scholar

About the article

Received: 2016-03-01

Accepted: 2016-07-05

Published Online: 2016-08-09

Published in Print: 2017-04-01


Citation Information: Biomedical Engineering / Biomedizinische Technik, ISSN (Online) 1862-278X, ISSN (Print) 0013-5585, DOI: https://doi.org/10.1515/bmt-2016-0052.

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