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

Simulators and Simulations for Extracorporeal Membrane Oxygenation: An ECMO Scoping Review

Classification; Extracorporeal life support; Simulation trainingClassificació; Suport vital extracorpòri; Formació en simulacióClasificación; Soporte vital extracorpóreo; Formación en simulaciónHigh-volume extracorporeal membrane oxygenation (ECMO) centers generally have better outcomes than (new) low-volume ECMO centers, most likely achieved by a suitable exposure to ECMO cases. To achieve a higher level of training, simulation-based training (SBT) offers an additional option for education and extended clinical skills. SBT could also help to improve the interdisciplinary team interactions. However, the level of ECMO simulators and/or simulations (ECMO sims) techniques may vary in purpose. We present a structured and objective classification of ECMO sims based on the broad experience of users and the developer for the available ECMO sims as low-, mid-, or high-fidelity. This classification is based on overall ECMO sim fidelity, established by taking the median of the definition-based fidelity, component fidelity, and customization fidelity as determined by expert opinion. According to this new classification, only low- and mid-fidelity ECMO sims are currently available. This comparison method may be used in the future for the description of new developments in ECMO sims, making it possible for ECMO sim designers, users, and researchers to compare accordingly, and ultimately improve ECMO patient outcomes.This research was funded by the 2022 “Boost Your Research” Fund in the Priority Program SPP 2014 “Towards an Implantable Lung” by the DFG, the German Research Foundation, grant number 20003297 UKA

Video based valve motion combined with Computational Fluid Dynamics gives stable and accurate simulations of blood flow in the Realheart® Total Artificial Heart

Background: Patients with end-stage, biventricular heart failure, and for whom heart transplantation is not an option, may be given a Total Artificial Heart (TAH). The Realheart® is a novel TAH which pumps blood by mimicking the native heart with translation of an atrioventricular plane. The aim of this work was to create a strategy for using Computational Fluid Dynamics (CFD) to simulate haemodynamics in the Realheart®, including motion of the atrioventricular plane and valves. Methods: The accuracies of four different computational methods for simulating fluid-structure interaction of the prosthetic valves were assessed by comparison of chamber pressures and flow rates with experimental measurements. The four strategies were: prescribed motion of valves opening and closing at the atrioventricular plane extrema; simulation of fluid-structure interaction of both valves; prescribed motion of the mitral valve with simulation of fluid-structure interaction of the aortic valve; motion of both valves prescribed from video analysis of experiments. Results: The most accurate strategy (error in ventricular pressure of 6%, error in flow rate of 5%) used video-prescribed motion. With the Realheart operating at 80 bpm, the power consumption was 1.03 W, maximum shear stress was 15 Pa, and washout of the ventricle chamber after 4 cycles was 87%.Conclusions: This study, the first CFD analysis of this novel TAH, demonstrates that good agreement between computational and experimental data can be achieved. This method will therefore enable future optimisation of the geometry and motion of the Realheart®

Circadian rhythms in pump parameters of patients on contemporary left ventricular assist device support

Background: Algorithms to monitor pump parameters are needed to further improve outcomes after left ventricular assist device (LVAD) implantation. Previous research showed a restored circadian rhythm in pump parameters in patients on HeartWare (HVAD) support. Circadian patterns in HeartMate3 (HM3) were not studied before, but this is important for the development of LVAD monitoring algorithms. Hence, we aimed to describe circadian patterns in HM3 parameters and their relation to patterns in heart rate (HR). Methods: 18 HM3 patients were included in this study. HM3 data were retrieved at a high frequency (one sample per 1 or 2 h) for 1–2 weeks. HR was measured using a wearable biosensor. To study overall patterns in HM3 parameters and HR, a heatmap was created. A 24-h cosine was fitted on power and HR separately. The relationship between the amplitude of the fitted cosines of power and HR was calculated using Spearman correlation. Results: A lower between patient variability was found in power compared with flow and PI. 83% of the patients showed a significant circadian rhythmicity in power (p < 0.001–0.04), with a clear morning increase. All patients showed significant circadian rhythmicity in HR (p < 0.001–0.02). The amplitudes of the circadian rhythm in power and HR were not correlated (Spearman correlation of 0.32, p = 0.19). Conclusions: A circadian rhythm of pump parameters is present in the majority of HM3 patients. Higher frequency pump parameter data should be collected, to enable early detection of complications in the future development of predictive algorithms

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