A physiological controller for turbodynamic ventricular assist devices based on a measurement of the left ventricular volume.

The current article presents a novel physiological control algorithm for ventricular assist devices (VADs), which is inspired by the preload recruitable stroke work. This controller adapts the hydraulic power output of the VAD to the end-diastolic volume of the left ventricle. We tested this controller on a hybrid mock circulation where the left ventricular volume (LVV) is known, i.e., the problem of measuring the LVV is not addressed in the current article. Experiments were conducted to compare the response of the controller with the physiological and with the pathological circulation, with and without VAD support. A sensitivity analysis was performed to analyze the influence of the controller parameters and the influence of the quality of the LVV signal on the performance of the control algorithm. The results show that the controller induces a response similar to the physiological circulation and effectively prevents over- and underpumping, i.e., ventricular suction and backflow from the aorta to the left ventricle, respectively. The same results are obtained in the case of a disturbed LVV signal. The results presented in the current article motivate the development of a robust, long-term stable sensor to measure the LVV.

[1]  Finn Gustafsson,et al.  Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). , 2009, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[2]  James F. Antaki,et al.  A Control System for Rotary Blood Pumps Based on Suction Detection , 2009, IEEE Transactions on Biomedical Engineering.

[3]  T Takano,et al.  Control system for an implantable rotary blood pump. , 2000, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[4]  K Araki,et al.  Control strategy for biventricular assistance with mixed-flow pumps. , 2000, Artificial organs.

[5]  B. Lampe,et al.  Physiological control of a rotary blood pump with selectable therapeutic options: control of pulsatility gradient. , 2008, Artificial organs.

[6]  Robert L Kormos,et al.  Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. , 2013, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[7]  S Takatani,et al.  Detection of suction and regurgitation of the implantable centrifugal pump based on the motor current waveform analysis and its application to optimization of pump flow. , 1999, Artificial organs.

[8]  Edward Bullister,et al.  Physiologic control algorithms for rotary blood pumps using pressure sensor input. , 2002, Artificial organs.

[9]  D. Glower,et al.  Linearity of the Frank-Starling relationship in the intact heart: the concept of preload recruitable stroke work. , 1985, Circulation.

[10]  T Sakamoto,et al.  Control strategy for rotary blood pumps. , 2001, Artificial organs.

[11]  K Araki,et al.  Sensorless controlling method for a continuous flow left ventricular assist device. , 2000, Artificial organs.

[12]  K Araki,et al.  Detection of total assist and sucking points based on pulsatility of a continuous flow artificial heart: in vitro evaluation. , 1998, ASAIO journal.

[13]  Guruprasad Giridharan,et al.  Achieving physiologic perfusion with ventricular assist devices: comparison of control strategies , 2005, Proceedings of the 2005, American Control Conference, 2005..

[14]  J.R. Boston,et al.  Control of heart assist devices , 2003, 42nd IEEE International Conference on Decision and Control (IEEE Cat. No.03CH37475).

[15]  Georg Wieselthaler,et al.  First clinical experience with an automatic control system for rotary blood pumps during ergometry and right-heart catheterization. , 2006, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[16]  James F. Antaki,et al.  A sensorless approach to control of a turbodynamic left ventricular assist system , 2001, IEEE Trans. Control. Syst. Technol..

[17]  Heinrich Schima,et al.  Dynamic Modeling and Identification of an Axial Flow Ventricular Assist Device , 2009, The International journal of artificial organs.

[18]  W. Frishman,et al.  Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure , 2007 .

[19]  Georg Wieselthaler,et al.  Development of a suction detection system for axial blood pumps. , 2004, Artificial organs.

[20]  Gregor Ochsner,et al.  Emulation of ventricular suction in a hybrid mock circulation , 2013, 2013 European Control Conference (ECC).

[21]  Kwan-Woong Gwak Application of Extremum Seeking Control to Turbodynamic Blood Pumps , 2007, ASAIO journal.

[22]  Georg Wieselthaler,et al.  Development of a reliable automatic speed control system for rotary blood pumps. , 2005, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[23]  F. Colacino,et al.  Left Ventricle Load Impedance Control by Apical VAD Can Help Heart Recovery and Patient Perfusion: A Numerical Study , 2007, ASAIO journal.

[24]  Daniel Timms,et al.  A review of clinical ventricular assist devices. , 2011, Medical engineering & physics.

[25]  Mikhail Skliar,et al.  Physiological control of blood pumps using intrinsic pump parameters: a computer simulation study. , 2006, Artificial organs.

[26]  Seongjin Choi,et al.  Hemodynamic controller for left ventricular assist device based on pulsatility ratio. , 2007, Artificial organs.

[27]  M Yokoyama,et al.  Comparison between preload recruitable stroke work and the end-systolic pressure-volume relationship in man. , 1992, European heart journal.

[28]  Gregor Ochsner,et al.  A Robust Reference Signal Generator for Synchronized Ventricular Assist Devices , 2013, IEEE Transactions on Biomedical Engineering.

[29]  James F. Antaki,et al.  Control issues in rotary heart assist devices , 2000, Proceedings of the 2000 American Control Conference. ACC (IEEE Cat. No.00CH36334).

[30]  A. Guyton,et al.  Textbook of Medical Physiology , 1961 .

[31]  Gang Tao,et al.  Modeling, Estimation, and Control of Human Circulatory System With a Left Ventricular Assist Device , 2007, IEEE Transactions on Control Systems Technology.

[32]  K Araki,et al.  Detection of total assist and sucking points based on the pulsatility of a continuous flow artificial heart: in vivo evaluation. , 1998, ASAIO journal.

[33]  Yukihiko Nosé,et al.  Flow characteristics and required control algorithm of an implantable centrifugal left ventricular assist device , 2008, Heart and Vessels.

[34]  U Losert,et al.  Noninvasive monitoring of rotary blood pumps: necessity, possibilities, and limitations. , 2008, Artificial organs.

[35]  S Takatani,et al.  Control of centrifugal blood pump based on the motor current. , 1997, Artificial organs.

[36]  J R Boston,et al.  Controller for an Axial Flow Blood Pump. , 1996, Artificial organs.

[37]  Marwan A. Simaan,et al.  Hierarchical control of heart-assist devices , 2003, IEEE Robotics Autom. Mag..

[38]  G Bearnson,et al.  Motor feedback physiological control for a continuous flow ventricular assist device. , 1999, Artificial organs.

[39]  Lino Guzzella,et al.  A Novel Interface for Hybrid Mock Circulations to Evaluate Ventricular Assist Devices , 2013, IEEE Transactions on Biomedical Engineering.