Physiological principles of Starling-like control of rotary ventricular assist devices

Stephens, Andrew F.; Gregory, Shaun D.; Burrell, Aidan; Marasco, Silvana; Salamonsen, Robert F.

doi:10.1080/17434440.2020.1841631

Cited by 9 publications

(5 citation statements)

References 73 publications

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“…The operation of commercial cfLVAD controllers relies on maintaining a constant blood flow pumping rate, and clinicians bear the responsibility of adjusting the flow when detecting a new need for assistance during routine visits [5]. However, the limitations of open-loop circuit control become apparent as patients strive to embrace an active lifestyle within their daily routines.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous-flow LVADs (cfLVADs) may encounter challenges related to balancing the assistance flow when changing posture and physical activity, such as insufficient pumping with/without reflux and excessive pumping with/without ventricular suction. Commercial cfLVAD controllers control the constant blood flow pumping rate, and clinicians adjust the flow when they detect a new need for assistance during periodic visits [5].…”

Section: Introductionmentioning

confidence: 99%

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Embedded Cyber-physical System for Physiological Control of Ventricular Assist Devices

Santos,

Leao,

Barboza

et al. 2024

Preprint

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Left Ventricular Assist Devices (LVADs) serve as both a bridge to transplantation and a destination therapy for managing congestive heart failure (CHF). However, the existing control strategy's inability to automatically adapt to hemodynamic changes can significantly impact patient survival rates and quality of life. Researchers have proposed various approaches to achieve Physiological Control over LVADs (PC-LVAD). Despite promising results, implementing these strategies on computers faces limitations due to substantial differences in controller characteristics between computers and embedded systems. An embedded cyber-physical system (CPS) was proposed to address this challenge, integrating real-time data processing, reconfigurable architecture, and communication protocols based on Health 4.0 concepts. To evaluate this embedded CPS, a multi-objective PC-LVAD was utilized in a hybrid cardiovascular simulator with an implanted LVAD, testing symmetry between the original proposal of the PC-LVAD and the version running on the embedded CPS. The embedded CPS demonstrated comparable results to the control executed on a computer, maintaining mean arterial pressure and cardiac output at physiological levels, even amid variations in ejection fraction. Furthermore, the pump's rotational speed was dynamically adjusted based on simulated clinical conditions, and no aortic reflux to the ventricle occurred through the LVAD during testing. These outcomes affirm the embedded CPS's satisfactory control performance. However, additional testing is imperative to validate its enhanced physiological strategies in embedded CPS during in vivo experiments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Embedded Cyber-physical System for Physiological Control of Ventricular Assist Devices

Santos,

Leao,

Barboza

et al. 2024

Preprint

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show abstract

“…More revolutionary goals include a ‘smart’ VAD that modulates pump flow to adapt to dynamic physiological needs and perhaps simulates more natural pulsatile flow synchronized with the patient’s native heart residual contractility. Early developments of such a dynamic VAD in simulations and animal models have been published, and the results are encouraging [ 71 , 72 , 73 , 74 , 75 ]. Another goal that can significantly improve quality of life and decrease infection risk is the development of a fully implantable device.…”

Section: Future Directionsmentioning

confidence: 99%

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

Berardi

Bravo

et al. 2022

JCM

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The utilization of left ventricular assist devices (LVADs) in end-stage heart failure has doubled in the past ten years and is bound to continue to increase. Since the first of these devices was approved in 1994, the technology has changed tremendously, and so has the medical and surgical management of these patients. In this review, we discuss the history of LVADs, evaluating survival and complications over time. We also aim to discuss practical aspects of the medical and surgical management of LVAD patients and future directions for outcome improvement in this population.

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“…Continuous-flow LVADs (cfLVADs) can experience challenges related to balancing the assist flow with changes in posture and physical activity, such as insufficient pumping with/without reflux and excessive pumping with/without ventricular suction. Commercial cfLVAD controllers control the constant blood flow pumping rate, and clinicians adjust the flow when they detect a new need for assistance during periodic visits [5]. The inability of devices to automatically respond to changes in demand can significantly impact the quality of life for these patients.…”

Section: Introductionmentioning

confidence: 99%

Embedded Cyber-Physical System for Physiological Control of Ventricular Assist Devices

Santos,

Leão,

Barboza Silva

et al. 2024

J. Electron. Electric. Eng.

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Ventricular Assist Devices (VADs) play a crucial role in both bridging to transplantation and serving as destination therapy for congestive heart failure (CHF) management. This study aims to address the limitations of existing control strategies for VADs, specifically their inability to adapt automatically to hemodynamic changes. It proposes a novel embedded cyber-physical system (CPS) based on real-time data processing, reconfigurable architecture, and communication protocols aligned with Health 4.0 concepts to enhance physiological control over VADs (PC-VAD). The research employs a multi-objective PC-VAD approach within a hybrid cardiovascular simulator. An embedded CPS is introduced to overcome challenges related to differences in controller characteristics between computers and embedded systems. The study assesses the performance of the embedded CPS by comparing it with a computer-based control system. The embedded CPS demonstrates outcomes comparable to the computer-based control system, maintaining mean arterial pressure and cardiac output at physiological levels. Even in the face of variations in ejection fraction, the embedded CPS dynamically adjusts the pump's rotational speed based on simulated clinical conditions. Notably, there is no aortic reflux to the ventricle through the VAD during testing. These findings affirm the satisfactory control performance of the embedded CPS in regulating VADs. The study concludes that the embedded CPS effectively addresses the limitations of current VAD control strategies, exhibiting control performance comparable to computer-based systems. However, further experimentation and in vivo studies are necessary to validate and ensure its applicability in real-world scenarios.

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Physiological principles of Starling-like control of rotary ventricular assist devices

Cited by 9 publications

References 73 publications

Embedded Cyber-physical System for Physiological Control of Ventricular Assist Devices

Embedded Cyber-physical System for Physiological Control of Ventricular Assist Devices

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

Embedded Cyber-Physical System for Physiological Control of Ventricular Assist Devices

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