Modeling andsimulationofspeedselectiononleftventricular assist devices

The control problem for LVADs is to set pump speed such that cardiac output and pressure perfusion are within acceptable physiological ranges. However, current technology of LVADs cannot provide for a closed-loop control scheme that can make adjustments based on the patient\u27s level of activity. In this context, the SensorART Speed Selection Module (SSM) integrates various hardware and software components in order to improve the quality of the patients\u27 treatment and the workflow of the specialists. It enables specialists to better understand the patient-device interactions, and improve their knowledge. The SensorART SSM includes two tools of the Specialist Decision Support System (SDSS); namely the Suction Detection Tool and the Speed Selection Tool. A VAD Heart Simulation Platform (VHSP) is also part of the system. The VHSP enables specialists to simulate the behavior of a patient?s circulatory system, using different LVAD types and functional parameters. The SDSS is a web-based application that offers specialists with a plethora of tools for monitoring, designing the best therapy plan, analyzing data, extracting new knowledge and making informative decisions. In this paper, two of these tools, the Suction Detection Tool and Speed Selection Tool are presented. The former allows the analysis of the simulations sessions from the VHSP and the identification of issues related to suction phenomenon with high accuracy 93%. The latter provides the specialists with a powerful support in their attempt to effectively plan the treatment strategy. It allows them to draw conclusions about the most appropriate pump speed settings. Preliminary assessments connecting the Suction Detection Tool to the VHSP are presented in this paper

MODERNIZATION OF THE MOCK CIRCULATORY LOOP: ADVANCED PHYSICAL MODELING, HIGH PERFORMANCE HARDWARE, AND INCORPORATION OF ANATOMICAL MODELS

A systemic mock circulatory loop plays a pivotal role as the in vitro assessment tool for left heart medical devices. The standard design employed by many research groups dates to the early 1970\u27s, and lacks the acuity needed for the advanced device designs currently being explored. The necessity to update the architecture of this in vitro tool has become apparent as the historical design fails to deliver the performance needed to simulate conditions and events that have been clinically identified as challenges for future device designs. In order to appropriately deliver the testing solution needed, a comprehensive evaluation of the functionality demanded must be understood. The resulting system is a fully automated systemic mock circulatory loop, inclusive of anatomical geometries at critical flow sections, and accompanying software tools to execute precise investigations of cardiac device performance. Delivering this complete testing solution will be achieved through three research aims: (1) Utilization of advanced physical modeling tools to develop a high fidelity computational model of the in vitro system. This model will enable control design of the logic that will govern the in vitro actuators, allow experimental settings to be evaluated prior to execution in the mock circulatory loop, and determination of system settings that replicate clinical patient data. (2) Deployment of a fully automated mock circulatory loop that allows for runtime control of all the settings needed to appropriately construct the conditions of interest. It is essential that the system is able to change set point on the fly; simulation of cardiovascular dynamics and event sequences require this functionality. The robustness of an automated system with incorporated closed loop control logic yields a mock circulatory loop with excellent reproducibility, which is essential for effective device evaluation. (3) Incorporating anatomical geometry at the critical device interfaces; ascending aorta and left atrium. These anatomies represent complex shapes; the flows present in these sections are complex and greatly affect device performance. Increasing the fidelity of the local flow fields at these interfaces delivers a more accurate representation of the device performance in vivo

Left Ventricular Assist Devices: Engineering Design Considerations

Patients with end-stage congestive heart failure awaiting heart transplantation often wait long periods of time (300 days or more on the average) before a suitable donor heart becomes available. The medical community has placed increased emphasis on the use of Left Ventricular Assist Devices or LVADs that can substitute for, or enhance, the function of the natural heart while the patient is waiting for the heart transplant (Poirier, 1997; Frazier & Myers, 1999). Essentially, a rotary LVAD is a pump that operates continuously directing blood from the left ventricle into the aorta by avoiding the aortic valve. Generally speaking, the goal of the LVAD is to assist the native heart in pumping blood through the circulatory system so as to provide the patient with as close to a normal lifestyle as possible until a donor heart becomes available or, in some cases, until the patient’s heart recovers. In many situations, this means allowing the patient to return home and/or to the workforce

Design and optimisation of an Intra-Aortic Shrouded rotor axial pump

Undesirable side effects in patients with a LVAD (Left Ventricular Assist Device) pump fitted include blood damage, thrombosis, blood traumatisation, and End-Organ Disfunctions. These side effects have generally been attributed to the high wall shear stresses and the induced turbulent flow. In this study, we introduce a novel design to address these effects by lowering the rotational speed and providing an optimum flow path design to minimise blood damage. We present an initial scheme for a new Intra-Aortic Shrouded Rotary Axial Pump and develop a sequence of pump geometries, for which the Taguchi Design Optimisation Method has been applied. We apply CFD tools to simulate the pressure rise, pump performance, hydraulic efficiency, wall shear stress, exposure time and mass flow rate. A prototype pump has been tested in a mock cardiovascular circuit using a water-glycerol solution. The optimum design delivered the desired pressure/mass flow rate characteristics at a significantly low rpm (2900 rpm). As a result, the estimated blood damage index is low, matching the design requirements. The theoretical performance was matched by experimental results. [Abstract copyright: Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.

Left Ventricular Assist Device Flow Pattern Analysis Using a Novel Model Incorporating Left Ventricular Pulsatility

Our current understanding of flow through the circuit of left ventricular assist device (LVAD), left ventricle and ascending aorta remains incompletely understood. Computational fluid dynamics, which allow for analysis of flow in the cardiovascular system, have been used for this purpose, although current simulation models have failed to fully incorporate the interplay between the pulsatile left ventricle and continuous-flow generated by the LVAD. Flow-through the LVAD is dependent on the interaction between device and patient-specific factors with suboptimal flow patterns evoking increased risk of LVAD-related complications. Computational fluid dynamics can be used to analyze how different pump and patient factors affect flow patterns in the left ventricle and the aorta. Computational fluid dynamics simulations were carried out on a patient with a HeartMate II. Simulations were also conducted for theoretical scenarios substituting HeartWare HVAD, HeartMate 3 (HM3) in continuous mode and HM3 with Artificial Pulse. An anatomical model of the patient was reconstructed from computed tomography (CT) images, and the LVAD outflow was used as the inflow boundary condition. The LVAD outflow was calculated separately using a lumped-parameter-model of the systemic circulation, which was calibrated to the patient based on the patient-specific ventricular volume change reconstructed from 4 dimensional computed tomography and pulmonary capillary wedge pressure tracings. The LVADs were implemented in the lumped-parameter-model via published pressure head versus flow (H-Q) curves. To quantify the flushing effect, virtual contrast agent was released in the ascending aorta and its flushing over the cycles was quantified. Shear stress acting on the aortic endothelium and shear rate in the bloodstream were also quantified as indicators of normal/abnormal blood flow, especially the latter being a biomarker of platelet activation and hemolysis. LVAD speeds for the HVAD and HM3 were selected to match flow rates for the patient’s HMII (9,000 RPM for HMII, 5,500 RPM for HM3, and 2,200 RPM for HVAD), the cardiac outputs were 5.81 L/min, 5.83 L/min, and 5.92 L/min, respectively. The velocity of blood flow in the outflow cannula was higher in the HVAD than in the two HeartMate pumps with a cycle average (range) of 0.92 m/s (0.78–1.19 m/s), 0.91 m/s (0.86–1.00 m/s), and 1.74 m/s (1.40–2.24 m/s) for HMII, HM3, and HVAD, respectively. Artificial pulse increased the peak flow rate to 9.84 L/min for the HM3 but the overall cardiac output was 5.96 L/min, which was similar to the continuous mode. Artificial pulse markedly decreased blood stagnation in the ascending aorta; after six cardiac cycles, 48% of the blood was flushed out from the ascending aorta under the continuous operation mode while 60% was flushed under artificial pulse. Shear stress and shear rate in the aortic arch were higher with the HVAD compared to the HMII and HM3, respectively (shear stress: 1.76 vs. 1.33 vs. 1.33 Pa, shear rate: 136 vs. 91.5 vs. 89.4 s–1). Pump-specific factors such as LVAD type and programmed flow algorithms lead to unique flow patterns which influence blood stagnation, shear stress, and platelet activation. The pump-patient interaction can be studied using a novel computational fluid dynamics model to better understand and potentially mitigate the risk of downstream LVAD complications

Computational Evaluation of Ventricular Assist Device Implementation in the Single Ventricle Circulation

Patients with a single ventricle congenital heart defect are prone to increased volume loading, which can lead to heart failure and require mechanical circulatory support. A ventricular assist device (VAD) can serve as a bridge treatment option for these patients. However, in VAD support cases, pediatric patients possessing congenital heart defects have lower survival rates than patients without and outcomes worsen further in single ventricle cases. Performance differences between pulsatile and continuous flow VADs have also been clinically observed, but the underlying mechanism remains poorly understood. Six pediatric, stage 1 single ventricle patients (cohort mean BSA = 0.30 m2) were considered. The cardiovascular system was computationally simulated using a lumped-parameter network (LPN) tuned to patient specific data. A first set of simulations emulated current clinical implementation of VADs in single ventricle patients. A second set modified VAD settings with the goal to further improve cardiac output (CO). For all patients, optimal CO was at least 1 L min-1 greater with the continuous flow VAD compared that of pulsatile flow (p=0.0009). The 25 and 50 mL pulsatile flow VADs exhibited incomplete filling at higher heart rates that reduced CO as much as 0.26 and 1.4 L min-1 (9.7% and 37.3%) below design expectations respectively. Optimization of pulsatile flow VAD settings to improve filling did not achieve statistically significant (p\u3c0.05) improvement. Results corroborate anecdotal clinical experience associating continuous flow VADs with superior CO and ventricular unloading in single ventricle patients. Future work should aim to improve models for ventricular suction resistance and the passive pressure-volume relationship at negative ventricular pressures. As part of future work, the single ventricle LPN was modified to simulate resting and exercise physiologies of example adult patients with normal bi-ventricular circulations. Correlations with exercise level for key physiological parameters were developed using prior literature data. Considerations for patient fitness level and age were also incorporated as appropriate. This model produced resting physiology within tolerance of prior literature data and exercise physiologies for two example patients within 10% of prior data for CO and mean arterial pressure. This modified LPN serves as a platform for future work in computational studies of bi-ventricular patients

Flow Dynamics in Cardiovascular Devices: A Comprehensive Review

This review explores flow dynamics in cardiovascular devices, focusing on fundamental fluid mechanics principles and normal blood flow patterns. It discusses the role of different structures in maintaining flow dynamics and the importance of stents, heart valves, artificial hearts, and ventricular assist devices in cardiovascular interventions. The review emphasizes the need for optimized designs and further research to enhance knowledge of flow dynamics in cardiovascular devices, advancing the field and improving patient care in cardiovascular interventions

Alternative heart assistance pump

2021 Spring.Includes bibliographical references.On average, the human heart beats around 115,000, and pumps around 2,000 gallons of blood daily. This essential organ may undergo systolic or diastolic dysfunction in which the heart cannot properly contract or relax, respectively. To help hearts pump effectively should these types of failures occur, ventricular assist devices (VAD) are implemented as a temporary or permanent solution. The most common VAD is the left ventricular assist device (LVAD) which supports the left ventricle in pumping the oxygen-rich blood from the heart to the aorta, and ultimately to the rest of the body. Although current VADs are an important treatment for advanced heart failure, generally VADS come with many complications and issues after implantation. These complications include incidents of hemolysis (tearing of the blood cells), thrombosis (clotting of the blood), bleeding (especially in the gastrointestinal tract), and infection at the driveline site. Specifically, the current continuous flow pumps are associated with a much higher incidence of gastrointestinal bleeding, myocardial perfusion, kidney problems, among others, compared with the earlier generation pulsatile pumps. However, the presence of several moving mechanical components made the pulsatile pumps less durable, bulky, and prone to malfunction, ultimately leading to favor toward continuous flow designs. The goal of the present study is to develop a novel heart assist pump, overcoming drawbacks to current commercially available pumps, by improving hemodynamic (blood flow) performance, pulsatility, and eliminating bleeding disorders. Our design will overcome the current pumps which suffer from non-physiological flow, and blood damage. The impact of this work goes beyond heart assist devices and would be applicable to other blood pumps. The fundamental biological and physical principles of designing a blood pump will be reviewed in chapter one. In addition, recent studies on current LVADs and the motivation behind these studies will also be discussed. Then, the idea of using a contractive tubular heart as an alternative pump will be presented in chapter two. To understand the pumping mechanism of the tubular heart, a detailed study on the embryonic heart is presented in this chapter. Subsequently, the effect of flow forces on blood cells will be studied in chapter 3. Moreover, the relation between flow regime and bleeding disorders have been studied in the same chapter. A discussion of our design, including the pump design, testing set up, experimental results will be presented in chapter 4. Finally, the limitations of the present study and future work will be presented in chapter 5