INFLUENCE OF PULSATILE CATHETER PUMP SYNCHRONIZATION ON HAEMODYNAMIC VARIABLES: NUMERICAL SIMULATION

Severe cardiovascular diseases can be treated using left ventricular assist devices (LVAD). One of the possible LVADs is the Pulsatile Catheter (PUCA) pump that consists of a hydraulically or pneumatically driven membrane pump connected to a valved catheter. In this work a numerical model of the cardiocirculatory system and of the PUCA have been developed in order to study their interaction. In the numerical simulator a pathological condition of the left ventricle has been reproduced and successively the effects of the PUCA on the haemodynamic variables applied were studied. Different functioning modes were tested by changing the ratio between the pump frequency and the heart beat rate (HR) as 1:1, 1:2 or 1:3 and by introducing a delay time between the cardiac and the PUCA cycle. The performance of the pump was evaluated in terms of cardiac output, PUCA and coronary flows and it was studied for different HR values. Results show a good resemblance between the model and literature data and indicate that different synchronization and timing can influence the functioning of the pump. In particular, the frequency ratio and the time delay of the pump cycle can contribute to optimize the performance of the PUCA

INFLUENCE OF PULSATILE CATHETER PUMP SYNCHRONIZATION ON HAEMODYNAMIC VARIABLES: NUMERICAL SIMULATION

Severe cardiovascular diseases can be treated using left ventricular assist devices (LVAD). One of the possible LVADs is the Pulsatile Catheter (PUCA) pump that consists of a hydraulically or pneumatically driven membrane pump connected to a valved catheter. In this work a numerical model of the cardiocirculatory system and of the PUCA have been developed in order to study their interaction. In the numerical simulator a pathological condition of the left ventricle has been reproduced and successively the effects of the PUCA on the haemodynamic variables applied were studied. Different functioning modes were tested by changing the ratio between the pump frequency and the heart beat rate (HR) as 1:1, 1:2 or 1:3 and by introducing a delay time between the cardiac and the PUCA cycle. The performance of the pump was evaluated in terms of cardiac output, PUCA and coronary flows and it was studied for different HR values. Results show a good resemblance between the model and literature data and indicate that different synchronization and timing can influence the functioning of the pump. In particular, the frequency ratio and the time delay of the pump cycle can contribute to optimize the performance of the PUCA

Influence of Pulsatile Catheter Pump Synchronization on Haemodynamic Variables: Numerical Simulation.

Severe cardiovascular diseases can be treated using left ventricular assist devices (LVAD). One of the possible LVADs is the Pulsatile Catheter (PUCA) pump that consists of a hydraulically or pneumatically driven membrane pump connected to a valved catheter. In this work a numerical model of the cardiocirculatory system and of the PUCA have been developed in order to study their interaction. In the numerical simulator a pathological condition of the left ventricle has been reproduced and successively the effects of the PUCA on the haemodynamic variables applied were studied. Different functioning modes were tested by changing the ratio between the pump frequency and the heart beat rate (HR) as 1:1, 1:2 or 1:3 and by introducing a delay time between the cardiac and the PUCA cycle. The performance of the pump was evaluated in terms of cardiac output, PUCA and coronary flows and it was studied for different HR values. Results show a good resemblance between the model and literature data and indicate that different synchronization and timing can influence the functioning of the pump. In particular, the frequency ratio and the time delay of the pump cycle can contribute to optimize the performance of the PUCA

VAD in failing Fontan: simulation of ventricular, cavo-pulmonary and biventricular assistance in systolic/diastolic ventricular dysfunction and in pulmonary vascular resistance increase.

Aim: Due to the lack of donors, VADs could be an alternative to heart transplantation for Failing Fontan patients (PTs). Considering the complex physiopathology and the type of VAD connection, a numerical model (NM) could be useful to support clinical decisions. The aim of this work is to test a NM simulating the VADs effects on failing Fontan for systolic dysfunction (SD), diastolic dysfunction (DD) and pulmonary vascular resistance increase (PRI). Methods: Data of 10 Fontan PTs were used to simulate the PTs baseline using a dedicated NM. Then, for each PTs a SD, a DD and a PRI were simulated. Finally, for each PT and for each pathology, the VADs implantation was simulated. Results: NM can well reproduce PTs baseline. In the case of SD, LVAD increases the cardiac output (CO) (35%) and the arterial systemic pressure (ASP) (25%). With cavo-pulmonary assistance (RVAD) a decrease of inferior vena cava pressure (IVCP) (39%) was observed with 34% increase of CO. With the BIVAD an increase of ASP (29%) and CO (37%) was observed. In the case of DD, the LVAD increases CO (42%), the RVAD decreases the IVCP. In the case of PRI, the highest CO (50%) and ASP (28%) increase is obtained with an RVAD together with the highest decrease of IVCP (53%). Conclusions: The use of NM could be helpful in this innovative field to evaluate the VADs implantation effects on specific PT to support PT and VAD selection

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

Role and applications of circulatory models in cardiovascular pathophysiology.

Circulatory models are relevant for research, education and prosthetic devices/components testing. Independently of its structure that can be numerical, physical or hybrid, the models can be used in different areas of cardiovascular pathophysiology. However, the models are often used to reproduce specific circulatory conditions instead of being used as "systemic" tools. That is to say, the models are used to evaluate the global effects of external disturbances such as pathologies, therapies, special environments or surgery on the circulatory system. Aim of this paper is to illustrate a family of circulatory models developed to represent the whole circulatory system in pathophysiological conditions describing some of the possible applications

Lipoprotein(a) Genotype Influences the Clinical Diagnosis of Familial Hypercholesterolemia

: Background Evidence suggests that LPA risk genotypes are a possible contributor to the clinical diagnosis of familial hypercholesterolemia (FH). This study aimed at determining the prevalence of LPA risk variants in adult individuals with FH enrolled in the Italian LIPIGEN (Lipid Transport Disorders Italian Genetic Network) study, with (FH/M+) or without (FH/M-) a causative genetic variant. Methods and Results An lp(a) [lipoprotein(a)] genetic score was calculated by summing the number risk-increasing alleles inherited at rs3798220 and rs10455872 variants. Overall, in the 4.6% of 1695 patients with clinically diagnosed FH, the phenotype was not explained by a monogenic or polygenic cause but by genotype associated with high lp(a) levels. Among 765 subjects with FH/M- and 930 subjects with FH/M+, 133 (17.4%) and 95 (10.2%) were characterized by 1 copy of either rs10455872 or rs3798220 or 2 copies of either rs10455872 or rs3798220 (lp(a) score ≥1). Subjects with FH/M- also had lower mean levels of pretreatment low-density lipoprotein cholesterol than individuals with FH/M+ (t test for difference in means between FH/M- and FH/M+ groups <0.0001); however, subjects with FH/M- and lp(a) score ≥1 had higher mean (SD) pretreatment low-density lipoprotein cholesterol levels (223.47 [50.40] mg/dL) compared with subjects with FH/M- and lp(a) score=0 (219.38 [54.54] mg/dL for), although not statistically significant. The adjustment of low-density lipoprotein cholesterol levels based on lp(a) concentration reduced from 68% to 42% the proportion of subjects with low-density lipoprotein cholesterol level ≥190 mg/dL (or from 68% to 50%, considering a more conservative formula). Conclusions Our study supports the importance of measuring lp(a) to perform the diagnosis of FH appropriately and to exclude that the observed phenotype is driven by elevated levels of lp(a) before performing the genetic test for FH

A Model of the Cardiorespiratory Response to Aerobic Exercise in Healthy and Heart Failure Conditions

The physiological response to physical exercise is now recognized as an important tool which can aid the diagnosis and treatment of cardiovascular diseases. This is due to the fact that several mechanisms are needed to accommodate a higher cardiac output and a higher oxygen delivery to tissues. The aim of the present work is to provide a fully closed loop cardiorespiratory simulator reproducing the main physiological mechanisms which arise during aerobic exercise. The simulator also provides a representation of the impairments of these mechanisms in heart failure condition and their effect on limiting exercise capacity. The simulator consists of a cardiovascular model including the left and right heart, pulmonary and systemic circulations. This latter is split into exercising and non-exercising regions and is controlled by the baroreflex and metabolic mechanisms. In addition, the simulator includes a respiratory model reproducing the gas exchange in lungs and tissues, the ventilation control and the effects of its mechanics on the cardiovascular system. The simulator was tested and compared to the data in the literature at three different workloads whilst cycling (25, 49 and 73 watts). The results show that the simulator is able to reproduce the response to exercise in terms of: heart rate (from 67 to 134 bpm), cardiac output (from 5.3 to 10.2 l/min), leg blood flow (from 0.7 to 3.0 l/min), peripheral resistance (from 0.9 to 0.5 mmHg/(cm(3)/s)), central arteriovenous oxygen difference (from 4.5 to 10.8 ml/dl) and ventilation (6.1-25.5 l/min). The simulator was further adapted to reproduce the main impairments observed in heart failure condition, such as reduced sensitivity of baroreflex and metabolic controls, lower perfusion to the exercising regions (from 0.6 to 1.4 l/min) and hyperventilation (from 9.2 to 40.2 l/min). The simulator we developed is a useful tool for the description of the basic physiological mechanisms operating during exercise. It can reproduce how these mechanisms interact and how their impairments could limit exercise performance in heart failure condition. The simulator can thus be used in the future as a test bench for different therapeutic strategies aimed at improving exercise performance in cardiopathic subjects.status: publishe

A model tool to study the combined effects of drug administration and LVAD assistance in pathophysiological circulatory conditions.

Aim: To develop a numerical tool to study the joint effect of Sodium Nitroprusside (SNP), baroreflex and left ventricular assist device (LVAD) on hemodynamics. Methods: A numerical model of the pharmaco-dynamic effect of SNP was developed and inserted into a lumped parameter circulatory model integrated with baroreflex and continuous flow LVAD (with atrio-aortic connection sub-models). The experiments were carried out in two steps. First step: the model was verified by comparing simulations with experimental data acquired from previous studies on Mongrel dogs in terms of mean arterial pressure (MAP), cardiac output (CO), heart rate (HR), total peripheral resistance and left ventricular properties. Second step: the combined action of SNP and LVAD was studied. Data were measured at LVAD off and at LVAD on (20000 and 24000 rpm). Results: At LVAD off, with a 2.5 ?g/kg/min SNP infusion under heart failure condition, the MAP reduced approximately 8%, CO and HR increased about 16% and 18%, respectively. In contrast, during assistance (24000 rpm) the changes in MAP, CO and HR were -9%, +12% and +20%, respectively. The effects of drug on hemodynamic parameters at different heart conditions were significantly different. Conclusions: The model provides insight into the complex interaction among baroreflex, drug infusion and LVAD and could be a support to clinical decisionmaking in cardiovascular pathologies. Acknowledgements: This work was supported by EU project SensorART (Grant number: 248763) and by Erasmus Mundus Masters Program (CEMACUBE)