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

Novel Pulsatile Cardiac Assist Pump

The project involve the research and development of a pulsatile, complex or continuous flow in biological and non-biological systems implantable heart assist pump. Specifically as a 20% cardiac assist for persons from congestive heart failure and other cardiac abnormalities. The pulsatile cardiac assist pump would provide upto 20% of the blood pumping process from the venous supply to the arterial supply. Current pumps are largely complete bypass pumps or large volume pumps that produce significant long term blood cell damage resulting in thrombosis. Most are not pulsatile which offers a significant physiological advantage. The pump under development is designed to prevent thrombosis by utilizing a unique geometry and pumping actuation mechanism. As part of the research we first used COSMOL simulation to aid in the design and blood flow dynamics. From these results we have designed a working prototype that can be configured in a number of geometries or stages. This design utilizes biocompatible material, Polyethylene oxide (PEO), which minimized protein interaction with the interior pumping surface. Shape memory alloy actuators compress the pumping chamber. Shape memory alloy actuators also actuate compression of the ingoing sphincter valve and outgoing sphincter valves. Pumping motion can be analyzed by accelerometers to provide optimized feedback and pump motion control. Zoned compression may allow optimal compression for blood flow. This type of pumping system biomimics actual heart compression and pulsation while the sphincter like valves minimizes thrombosis causing turbulent. A second actuation method may be employed utilizing pneumatic cuffs that inflate and compress the pump body and sphincter valves. The pump has a minimum of one hundred twenty mmHg pressure capabilities at fifty to one hundred and fifty beats per minute or in coordination with the compression and decompression rate of the heart as measured by blood pressure sensors or direct heart electro cardiac sensing. A cluster of pumps each independently controlled may be packaged for sequence or sequential actuation providing complex pumping and flow patterns or continuous pumping flow. Further the pumps may be independently actuated in a tandem configuration. As such the pump provides a broad field of use including but not limited to arterial to arterial pumping, drug delivery, physiological fluidic maintenance, intravenous delivery, pressure maintenance and drug manufacturing where low turbulence flow is required and any pulsatile, complex flow pattern or continuous flow pattern is required

Suction Detection And Feedback Control For The Rotary Left Ventricular Assist Device

The Left Ventricular Assist Device (LVAD) is a rotary mechanical pump that is implanted in patients with congestive heart failure to help the left ventricle in pumping blood in the circulatory system. The rotary type pumps are controlled by varying the pump motor current to adjust the amount of blood flowing through the LVAD. One important challenge in using such a device is the desire to provide the patient with as close to a normal lifestyle as possible until a donor heart becomes available. The development of an appropriate feedback controller that is capable of automatically adjusting the pump current is therefore a crucial step in meeting this challenge. In addition to being able to adapt to changes in the patient\u27s daily activities, the controller must be able to prevent the occurrence of excessive pumping of blood from the left ventricle (a phenomenon known as ventricular suction) that may cause collapse of the left ventricle and damage to the heart muscle and tissues. In this dissertation, we present a new suction detection system that can precisely classify pump flow patterns, based on a Lagrangian Support Vector Machine (LSVM) model that combines six suction indices extracted from the pump flow signal to make a decision about whether the pump is not in suction, approaching suction, or in suction. The proposed method has been tested using in vivo experimental data based on two different LVAD pumps. The results show that the system can produce superior performance in terms of classification accuracy, stability, learning speed, iv and good robustness compared to three other existing suction detection methods and the original SVM-based algorithm. The ability of the proposed algorithm to detect suction provides a reliable platform for the development of a feedback control system to control the current of the pump (input variable) while at the same time ensuring that suction is avoided. Based on the proposed suction detector, a new control system for the rotary LVAD was developed to automatically regulate the pump current of the device to avoid ventricular suction. The control system consists of an LSVM suction detector and a feedback controller. The LSVM suction detector is activated first so as to correctly classify the pump status as No Suction (NS) or Suction (S). When the detection is “No Suction”, the feedback controller is activated so as to automatically adjust the pump current in order that the blood flow requirements of the patient’s body at different physiological states are met according to the patient’s activity level. When the detection is “Suction”, the pump current is immediately decreased in order to drive the pump back to a normal No Suction operating condition. The performance of the control system was tested in simulations over a wide range of physiological conditions

A New Development Of Feedback Controller For Left Ventricular Assist Device

The rotary Left Ventricular Assist Device (LVAD) is a mechanical pump surgically implanted in patients with end-stage congestive heart failure to help maintain the flow of blood from the sick heart. The rotary type pumps are controlled by varying the impeller speed to control the amount of blood flowing through the LVAD. One important challenge in using these devices is to prevent the occurrence of excessive pumping of blood from the left ventricle (known as suction) that may cause it to collapse due to the high pump speed. The development of a proper feedback controller for the pump speed is therefore crucial to meet this challenge. In this thesis, some theoretical and practical issues related to the development of such a controller are discussed. First, a basic nonlinear, time-varying cardiovascular-LVAD circuit model that will be used to develop the controller is reviewed. Using this model, a suction index is tested to detect suction. Finally we propose a feedback controller that uses the pump flow signal to regulate the pump speed based on the suction index and an associated threshold. The objective of this controller is to continuously update the pump speed to adapt to the physiological changes of the patient while at the same time avoiding suction. Simulation results are presented under different conditions of the patient activities. Robustness of the controller to measurement noise is also discussed

Design and development of a pulsatile axial flow blood pump as a left ventricular assist device

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonEach year all over the world, Millions of patients from infants to adults are diagnosed with heart failure. A limited number of donor hearts available for these patients results in a tremendous demand of mechanical circulatory support (MCS) system, either in the form of total artificial heart (TAH) or a ventricular assist device (VAD). Physiologically MCS are expected to provide heart; a time to rest and potential recovery by unloading the ventricle, while maintaining the adequate peripheral as well as coronary circulation. Existing ventricular assist devices (VAD) have employed either displacement type pulsatile flow pumping systems or continuous flow type centrifugal/rotodynamic pumps systems. Displacement type devices produce a pulsatile outflow, which has significant benefits on vital organ function and end organ recovery. Continuous flow devices are small and can be placed within body using minimal invasive procedures, in addition they reduces infection as well as mechanical failure related complications. Despite availability of success stories for both types of pumping systems, the selection of the either of them is an ongoing debate. This thesis aims to merge the advantages of displacement pumps (pulsatile flow) and axial-flow pumps (continuous flow) into a novel left vertical assist device (LVAD), by designing a novel minimal invasive, miniature axial-flow pump producing pulsating outflow for the patients having early heart failure and myocardial infarction as a Bridge-To-Recovery (BTR) or Bridge-To-Decision (BTD) device. The design of VAD, the experimental setup and dedicated control system were developed for the in vitro evaluation of pulsatile flow. Computational fluid dynamics (CFD) had been employed for the detail investigation of pulsatile flow. In addition, CFD was also applied to optimize the pulse generation for low haemolysis levels. Outcome of the study produces comprehensive understanding for the generation of pulsatile flow using an axial flow pump. Further, it provides the means of generating a controlled pulse that can regulate flow rate for varying heart rate within low haemolysis levels

Doctor of Philosophy

dissertationHeart disease is the leading cause of death in the United States. Mechanical circulatory support by ventricular assist devices (VADs) is a means by which deteriorating heart function can be supplemented, and is a leading therapy for latestage heart failure patients. The devices are commonly connected to the apex of the left ventricle (LV) to move oxygenated blood to the body via the aorta. Recent developments have made continuous-flow pumps commonplace in the clinical environment when compared to their pulsatile-flow predecessors. Typically, continuous-flow VADs are designed with axial- or centrifugal- (radial) configurations. The pressures and flow rates vary dramatically in the native heart as blood is moved from the LV to the aorta. This dissertation presents pressure-flow characteristics for both axial- and centrifugal-flow VADs within a wide range of pressure differential values under uniform conditions, by means of a novel, open-loop flow system. Current techniques employ a closed-loop system to determine pump performance. A closed-loop system does not allow pressure differentials less than or equal to zero to be achieved. The native heart experiences pressure gradients near zero across the aortic valve during systole, which is essentially where the VAD is placed. Thus, an open-loop flow system with independently adjustable preload and afterload pressures is required to reach physiologically-relevant pressure differential regions that approximate the pressure gradient across the aortic valve during systole. Additional modifications made to the open-loop flow system generate pulsatile flow type conditions, which mimic those of the native LV. With this type of in vitro test system, not only can general hydrodynamic performance and hydraulic efficiency of VADs be measured, but also off-design operational performance under dynamic flow conditions can be characterized. This research explores hydrodynamic performance characteristics of axial- and centrifugal-flow VADs to determine design advantages that each have. Device characteristics include pressure-flow performance curves, pressure sensitivity, pulsatility index, and pulsatility ratio. Performance curves and other relevant attributes are investigated at previously unreported pressure-flow regions. Performance is evaluated theoretically, computationally, and experimentally under both steady-state, continuous-flow and pulsatile-flow circumstances

Be still, my beating heart: reading pulselessness from Shakespeare to the artificial heart

Today, heart failure patients can be kept alive by an artificial heart while they await a heart transplant. These modern artificial hearts, or left ventricular assist devices (LVADs), remove the patient’s discernible pulse whilst still maintaining life. This technology contradicts physiological, historical and sociocultural understandings of the pulse as central to human life. In this essay, we consider the ramifications of this contrast between the historical and cultural importance placed on the pulse (especially in relation to our sense of self) and living with a pulseless LVAD. We argue that the pulse’s relationship to individual identity can be rescripted by examining its representation in formative cultural texts like the works of William Shakespeare. Through an integration of historical, literary and biomedical engineering perspectives on the pulse, this paper expands interpretations of pulselessness and advocates for the importance of cultural – as well as biomedical – knowledge to support LVAD patients and those around them. In reconsidering figurative and literal representations of the heartbeat in the context of technology which removes the need for a pulse, this essay argues that narrative and metaphor can be used to reconceptualise the relationship between the heartbeat and identity

Development and applications of in-vitro and in-silico models of the cardiovascular system to study the effects of mechanical circulatory support.

Cardiovascular diseases (CVDs) are the leading cause of mortality globally. With ongoing interest in CVDs treatment, preclinical models for drug/therapeutic development that allow for fast iterative research are needed. Owing to the inherent complexity of the cardiovascular system, current in-vitro models of the cardiovascular system fail to replicate many of the physiological aspects of the cardiovascular system. In this dissertation, the main concern is with heart failure (HF). In advanced HF, patients may receive Left Ventricular Assist Devices (LVADs) as a bridge to transplant or destination therapy. However, LVADs have many limitations, including inability to adapt to varying tissue demand conditions, risk of ventricular suction, and diminished arterial pulsatility. To address these issues, this dissertation aims to use and develop computer, cellular, and tissue models of the cardiovascular system. 1) Use an in-silico model of the cardiovascular system to develop a novel control algorithm for LVADs. The control system was rigorously tested and showed adequate perfusion during rest and exercise, protect against ventricular suction under reduced heart preload, and augment arterial pulsatility through pulse modulation without requiring sensor implantation or model-based estimations. 2) While pulsatility augmentation was feasible through the developed control algorithm, the pulse waveform that could normalize the vascular phenotype is unknown. To address this, an endothelial cell-smooth muscle cell microfluidic coculture model was developed to recreate the physiological mechanical stimulants in the vascular wall. The results demonstrated different effects of pulsatile shear stress and stretch on endothelial cells and may indicate that a pulse pressure of at least 30 mmHg is needed to maintain normal endothelial morphology. 3) In order to study the effects of mechanical unloading on the native ventricle, a novel cardiac tissue culture model (CTCM) was developed. CTCM provided physiological electromechanical and humoral stimulation with 25% preload stretch and thyroid and glucocorticoid treatment maintained the cardiac phenotype for 12 days. The device was thoroughly characterized and tested. Results demonstrated improved viability, energy utilization, fibrotic remodeling, and structural integrity compared to available culture systems. The system was also used to reproduce ventricular volume-overload and the results demonstrated hypertrophic and fibrotic remodeling, typical of volume-overload pathology