In-silico hemodynamic ramp testing of ventricular assist device implanted patients using acausal cardiovascular-VAD modeling.

BACKGROUND While cardiovascular system and mechanical circulatory support devices are efficiently model the effect of disease and assistance, they can also lend valuable insights into clinical procedures. This study demonstrates the use of a CVS-VAD model for an invasive procedure; hemodynamic ramp testing, in-silico. METHODS The CVS model is developed using validated models in literature, using Simscape™. An analytically derived pump model is calibrated for the HeartWare VAD. Dilated cardiomyopathy is used as an illustrative example of heart failure, and heart failure patients are created virtually by calibrating the model with requisite disease parameters obtained from published patient data. A clinically applied ramp study protocol is adopted whereby speed optimization is performed following clinically accepted hemodynamic normalization criteria. Trends in hemodynamic variables in response to pump speed increments are obtained. Optimal speed ranges are obtained for the three virtual patients based on target values of Central Venous Pressure (CVP), Pulmonary Capillary Wedge Pressure (PCWP), Cardiac Output (CO), and Mean Arterial Pressure (MAP) for hemodynamic stabilization. RESULTS Appreciable speed changes in the mild case (300 rpm), slight changes in the moderate case (100 rpm), and no changes in the simulated severe case are possible. CONCLUSION The study demonstrates a novel application of cardiovascular modeling using an open-source acausal model, which can be potentially beneficial for medical education and research.