Treatment-Specific Approaches for Analysis and Control of Left Ventricular Assist Devices

A Left Ventricular Assist Device (LVAD) is a mechanical pump that helps patients with heart failure conditions. This rotary pump works in parallel to the ailing heart and provides an alternative path for blood flow from the weak left ventricle to the aorta. The LVAD is controlled by the power supplied to the pump motor. An increase in the pump motor power increases the pump speed and the pump flow. The LVAD is typically controlled at a fixed setting of pump power. This basically means that the controller does not react to any change in the activity level of the patient. An important engineering challenge is to develop an LVAD feedback controller that can automatically adjusts its pump motor power so that the resulting pump flow matches the physiological demand of the patient. To this end, the development of a mathematical model that can be used to accurately simulate the interaction between the cardiovascular system of the patient and the LVAD is essential for the controller design. The use of such a dynamic model helps engineers and physicians in testing their theories, assessing the effectiveness of prescribed treatments, and understanding in depth the characteristics of this coupled bio-mechanical system. The first contribution of this dissertation is the development of a pump power-based model for the cardiovascular-LVAD system. Previously, the mathematical models in the literature assume availability of the pump speed as an independent control variable. In reality, however, the device is controlled by pump motor power which, in turn, produces the rotational pump speed. The nonlinear relationship between the supplied power and the speed is derived, and interesting observations about the pump speed signal are documented. The second contribution is the development of a feedback controller for patients using an LVAD as either a destination therapy or a bridge to transplant device. The main objective of designing this controller is to provide a physiological demand of the patient equivalent of that of a healthy individual. Since the device is implanted for a long period of time, this objective is chosen to allow the patient to live a life as close to normal as possible. The third contribution is an analysis of the aortic valve dynamics under the support of an LVAD. The aortic valve may experiences a permanent closure when the LVAD pump power is increased too much. The permanent closure of the aortic valve can be very harmful to the patients using the device as a bridge to recovery treatments. The analysis illustrates the various changes in the hemodynamic variables of the patient as a result of aortic valve closing. The results establish the relationship between the activity level and the heart failure severity with respect to the duration of the aortic valve opening

A New Control System for Left Ventricular Assist Devices Based on Patient-specific Physiological Demand

A left ventricular assist device (LVAD) is a mechanical pump that helps patients with a heart failure (HF) condition. This pump works in parallel to the ailing heart and provides a continuous flow from the weak left ventricle to the ascending aorta. The current supplied to the pump motor controls the flow of blood. A new feedback control system is developed to automatically adjust the pump motor current to provide the blood flow required by the level of activity of the patient. The systemic vascular resistance (RS) is the only undeterministic variable parameter in a patient-specific model and also a key value that expresses the level of activity of the patient. The rest of the parameters are constants for a patient-specific model. To determine the level of activity of the patient, an inverse problem approach is followed. The output data (pump flow) are observed and using an optimized search technique, the best model to describe such output is selected. Furthermore, the estimated RS is used in another patient-specific cardiovascular model that assumes a healthy heart, to determine the blood flow demand. Once the physiological demand is established, the current supplied to the pump motor of the LVAD can be adjusted to achieve the desired blood flow through the cardiovascular system. This process can be performed automatically in a real-time basis using information that is readily available and thus rendering a high degree of applicability. Results from simulated data show that the feedback control system is fast and very stable

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

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

An Engineering Analysis of the Aortic Valve Dynamics in Patients with Rotary Left Ventricular Assist Devices

The use of a rotary Left Ventricular Assist Device (LVAD) as a bridge-to-recovery treatment is gaining considerable attention in the LVAD research community. Using a mathematical model of the cardiovascular-LVAD system, this paper intends to define the critical control parameters in terms of power and rotational speed of the LVAD to ensure normal dynamics of the aortic valve for different levels of patient's activity and severity of heart failure. The effects of permanent closure of the aortic valve on the hemodynamics of the patient and the pump flow characteristics, if the critical control values are exceeded, are also examined. Additionally, LVAD power and speed control parameters that yield a given percentage of the cardiac cycle during which the aortic valve remains open are examined indicating that the severity of the heart failure is a very important factor in deciding the appropriateness of the LVAD as a bridge-to recovery treatment

An Engineering Analysis Of The Aortic Valve Dynamics In Patients With Rotary Left Ventricular Assist Devices

The use of a rotary Left Ventricular Assist Device (LVAD) as a bridge-to-recovery treatment is gaining considerable attention in the LVAD research community. Using a mathematical model of the cardiovascular-LVAD system, this paper intends to define the critical control parameters in terms of power and rotational speed of the LVAD to ensure normal dynamics of the aortic valve for different levels of patient\u27s activity and severity of heart failure. The effects of permanent closure of the aortic valve on the hemodynamics of the patient and the pump flow characteristics, if the critical control values are exceeded, are also examined. Additionally, LVAD power and speed control parameters that yield a given percentage of the cardiac cycle during which the aortic valve remains open are examined indicating that the severity of the heart failure is a very important factor in deciding the appropriateness of the LVAD as a bridge-to recovery treatment

The Aortic Valve Dynamics Role In The Recovery Treatments Of Patients With Left Ventricular Assist Devices

This paper intends to define an optimal range for the pump speed of Rotary Left Ventricular Assist Devices (LVADs) that are used in bridge-to-recovery treatments. If the pump is operating within that optimal range, the aortic valve will be working properly (i.e. opening and closing) in each cardiac cycle. The proper operation of the aortic valve is a very important factor in helping the heart muscle recovers. The optimal range varies depending on the severity of the Heart Failure (HF) and the level of activity of the patient. A comparison is shown between the total flow produced as a result of operating the pump within the optimal range and the physiological demand of the patient. The comparison suggests that for cases of mild to moderate HF the flow produced is close to the physiological demand, but in severe cases the flow is significantly less than what the patient requires. Furthermore, our results suggest that data from the pump flow and the left ventricle volume signals can be used to test whether or not the aortic valve is experiencing permanent closure. Also an investigation of the aortic valve opening duration is presented for two cases: first, for mild HF case with varying Heart Rate (HR) and then for fixed HR and mild to severe HF cases. These Simulation results are obtained using a 6 th order mathematical model of the cardiovascular-LVAD system. © 2011 IEEE

Detection of aortic valve dynamics in bridge-to-recovery feedback control of the Left Ventricular Assist Device

Aortic valve dynamics - which implies continuous opening and closing of the aortic valve in each cardiac cycle during the feedback control of the rotary Left Ventricular Assist Devices (LVAD) support - has important clinical implications for patients with mild congestive heart failure. When the LVAD is implanted in such patients as a bridge-to-recovery device, permanent closure of the aortic valve must be avoided by maintaining proper control on the power delivered to the device. In this paper, a new aortic valve dynamics detection algorithm based on a Lagrangian Support Vector Machine (LSVM) model is presented. A detection indicator is derived from the systemic vascular flow signal in the circulatory system using a nonlinear mathematical model of the combined cardiovascular-LVAD system and forms the input to the LSVM classifier. The LSVM classifier is trained and tested to classify the aortic valve dynamics into two states: aortic valve opening and closing (i.e. operating normally) and aortic valve permanently closed. Our results show that the proposed algorithm can detect the aortic valve dynamics effectively in terms of classification accuracy and stability. This classifier will be an integral part in the development of a feedback controller for the LVAD when used on patients as a bridge-to-recovery device. The output of the classifier will be used to adjust the power delivered to the LVAD to ensure that the aortic valve opens and closes normally within each cardiac cycle while at the same time making sure that the physiological demands of the patient are met

A New Control System for Left Ventricular Assist Devices Based on Patient-specific Physiological Demand

A left ventricular assist device (LVAD) is a mechanical pump that helps patients with a heart failure (HF) condition. This pump works in parallel to the ailing heart and provides a continuous flow from the weak left ventricle to the ascending aorta. The current supplied to the pump motor controls the flow of blood. A new feedback control system is developed to automatically adjust the pump motor current to provide the blood flow required by the level of activity of the patient. The systemic vascular resistance (RS) is the only undeterministic variable parameter in a patient-specific model and also a key value that expresses the level of activity of the patient. The rest of the parameters are constants for a patient-specific model. To determine the level of activity of the patient, an inverse problem approach is followed. The output data (pump flow) are observed and using an optimized search technique, the best model to describe such output is selected. Furthermore, the estimated RS is used in another patient-specific cardiovascular model that assumes a healthy heart, to determine the blood flow demand. Once the physiological demand is established, the current supplied to the pump motor of the LVAD can be adjusted to achieve the desired blood flow through the cardiovascular system. This process can be performed automatically in a real-time basis using information that is readily available and thus rendering a high degree of applicability. Results from simulated data show that the feedback control system is fast and very stable

A New Control System For Left Ventricular Assist Devices Based On Patient-Specific Physiological Demand

A left ventricular assist device (LVAD) is a mechanical pump that helps patients with a heart failure (HF) condition. This pump works in parallel to the ailing heart and provides a continuous flow from the weak left ventricle to the ascending aorta. The current supplied to the pump motor controls the flow of blood. A new feedback control system is developed to automatically adjust the pump motor current to provide the blood flow required by the level of activity of the patient. The systemic vascular resistance (R S) is the only undeterministic variable parameter in a patient-specific model and also a key value that expresses the level of activity of the patient. The rest of the parameters are constants for a patient-specific model. To determine the level of activity of the patient, an inverse problem approach is followed. The output data (pump flow) are observed and using an optimized search technique, the best model to describe such output is selected. Furthermore, the estimated R S is used in another patient-specific cardiovascular model that assumes a healthy heart, to determine the blood flow demand. Once the physiological demand is established, the current supplied to the pump motor of the LVAD can be adjusted to achieve the desired blood flow through the cardiovascular system. This process can be performed automatically in a real-time basis using information that is readily available and thus rendering a high degree of applicability. Results from simulated data show that the feedback control system is fast and very stable. © 2012 Copyright Taylor and Francis Group, LLC