Study on the synchronization of biventricular beats with the control mode of left ventricular assist device_Journal of Biomedical Engineering

Authors：

 WANG Fangqun ¹ , ZHANG Yao ¹ , HE Wanqian ¹ , CHEN Si ² , JING Teng ² , ZHANG Zhihao ¹

1. School of Electrical and Information Engineering, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R.China;
2. School of Fluid Machinery and Technology, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R.China;

Corresponding author：

WANG Fangqun, Email: lingo@ujs.edu.cn

Keywords：

left ventricular assist device; right ventricle failure; synchronization; counter-pulse mode

DOI：

10.7507/1001-5515.202001046

Video：

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Right ventricular (RV) failure has become a deadly complication of left ventricular assist device (LVAD) implantation, for which desynchrony in bi-ventricular pulse resulting from a LVAD is among the important factor. This paper investigated how different control modes affect the synchronization of pulse between LV (left ventricular) and RV by numerical method. The numerical results showed that the systolic duration between LV and RV did not significantly differ at baseline (LVAD off and cannula clamped) (48.52% vs. 51.77%, respectively). The systolic period was significantly shorter than the RV systolic period in the continuous-flow mode (LV vs. RV: 24.38% vs. 49.16%) and the LV systolic period at baseline. The LV systolic duration was significantly shorter than the RV systolic duration in the pulse mode (LV vs. RV: 28.38% vs. 50.41%), but longer than the LV systolic duration in the continuous-flow mode. There was no significant difference between the LV and RV systolic periods in the counter-pulse mode (LV vs. RV: 43.13% vs. 49.23%). However, the LV systolic periods was shorter than the no-pump mode and much longer than the continuous-flow mode. Compared with continuous-flow and pulse mode, the reduction in rotational speed (RS) brought out by counter-pulse mode significantly corrected the duration of LV systolic phase. The shortened duration of systolic phase in the continuous-flow mode was corrected as re-synchronization in the counter-pulse mode between LV and RV. Hence, we postulated that the beneficial effects on RV function were due to re-synchronizing of RV and LV contraction. In conclusion, decreased RS delivered during the systolic phase using the counter-pulse mode holds promise for the clinical correction of desynchrony in bi-ventricular pulse resulting from a LVAD and confers a benefit on RV function.

Citation： WANG Fangqun, ZHANG Yao, HE Wanqian, CHEN Si, JING Teng, ZHANG Zhihao. Study on the synchronization of biventricular beats with the control mode of left ventricular assist device. Journal of Biomedical Engineering, 2021, 38(1): 72-79. doi: 10.7507/1001-5515.202001046 Copy

1.	Wang Y, Koenig S C, Wu Z J, et al. Sensorless physiologic control, suction prevention, and flow balancing algorithm for rotary biventricular assist devices. IEEE Trans Control Syst Technol, 2017, 27(2): 717-729.
2.	Volkovicher N, Kurihara C, Critsinelis A. Outcomes in patients with advanced heart failure and small body size undergoing continuous-flow left ventricular assist device implantation. J Artif Organs, 2018, 21(1): 31-38.
3.	Demirozu Z T, Arat N, Kucukaksu D S. Fine-tuning management of the Heart Assist 5 left ventricular assist device with two- and three-dimensional echocardiography. Cardiovasc J Afr, 2016, 27(4): 208-212.
4.	龙东平, 薛建荣, 云忠. 心室辅助装置血泵内血栓控制研究进展. 中国胸心血管外科临床杂志, 2020, 27(10): 1235-1241.
5.	Slaughter M S, Rogers J G, Milano C A, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med, 2009, 361(23): 2241-2251.
6.	Ng B C, Salamonsen R F, Gregory S D, et al. Application of multiobjective neural predictive control to biventricular assistance using dual rotary blood pumps. Biomed Signal Process Control, 2018, 39: 81-93.
7.	Chow E, Farrar D J. Effects of left ventricular pressure reductions on right ventricular systolic performance. Am J Physiol Heart Circ Physiol, 1989, 257(6 Pt 2): H1878-85.
8.	Moon M R, Castro L J, DeAnda A, et al. Right ventricular dynamics during left ventricular assistance in closed-chest dogs. Ann Thorac Surg, 1993, 56(1): 54-67.
9.	Farrar D J, Chow E, Compton P G, et al. Effects of acute right ventricular ischemia on ventricular interactions during prosthetic left ventricular support. J Thorac Cardiovasc Surg, 1991, 102(4): 588-595.
10.	Omoto T, Tanabe H, Laria P, et al. Right ventricular performance during left ventricular unloading conditions: the contribution of the right ventricular free wall. J Thorac Cardiovasc Surg, 2002, 50(1): 16-20.
11.	Park C H, Nishimura K, Kitano M, et al. Right ventricular performance is impaired by full assist of left heart bypass: analysis of right ventricular performance against change in afterload in heart failure models. ASAIO J, 1994, 40(3): M303-M308.
12.	Kitano M, Nishimura K, Hee P C, et al. Right ventricular function evaluated by volumetric analysis during left heart bypass in a canine model of postischemic cardiac dysfunction. J Thorac Cardiovasc Surg, 1995, 109(4): 796-803.
13.	Daly R C, Chandrasekaran K, Cavarocchi N C, et al. Ischemia of the interventricular septum. A mechanism of right ventricular failure during mechanical left ventricular assist. J Thorac Cardiovasc Surg, 1992, 103(6): 1186-1191.
14.	杨新娟, 王秉臣, 崔炜. 慢性心力衰竭患者双心室收缩同步性与其结构研究. 中国心血管杂志, 2006, 11(4): 257-260.
15.	Yoshioka D, Sakaguchi T, Saito S, et al. Predictor of early mortality for severe heart failure patients with left ventricular assist device implantation: significance of INTERMACS level and renal function. Circ J, 2012, 76(7): 1631-1638.
16.	Aissaoui N, Morshuis M, Schoenbrodt M, et al. Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients. J Thorac Cardiovasc Surg, 2013, 146(1): 186-191.
17.	Arakawa M, Nishimura T, Takewa Y, et al. Novel control system to prevent right ventricular failure induced by rotary blood pump. J Artif Organs, 2014, 17(2): 135-141.
18.	王芳群, 徐庆, 吴振海, 等. 基于左心辅助的血液循环系统的控制研究. 生物医学工程学杂志, 2016, 33(6): 1075-1083.
19.	Suga H, Sagawa K. Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res, 1974, 35(1): 117-126.
20.	Korakianitis T, Shi Y. Numerical simulation of cardiovascular dynamics with healthy and diseased heart valves. J Biomech, 2006, 39(11): 1964-1982.
21.	Bozkurt S. Arterial pulsatility and aortic valve function under continuous flow left ventricular assist device support, continuous speed vs. varying speed pump assistance. Ann Biomed Eng, 2015, 43: 1727-1737.

1. Wang Y, Koenig S C, Wu Z J, et al. Sensorless physiologic control, suction prevention, and flow balancing algorithm for rotary biventricular assist devices. IEEE Trans Control Syst Technol, 2017, 27(2): 717-729.
2. Volkovicher N, Kurihara C, Critsinelis A. Outcomes in patients with advanced heart failure and small body size undergoing continuous-flow left ventricular assist device implantation. J Artif Organs, 2018, 21(1): 31-38.
3. Demirozu Z T, Arat N, Kucukaksu D S. Fine-tuning management of the Heart Assist 5 left ventricular assist device with two- and three-dimensional echocardiography. Cardiovasc J Afr, 2016, 27(4): 208-212.
4. 龙东平, 薛建荣, 云忠. 心室辅助装置血泵内血栓控制研究进展. 中国胸心血管外科临床杂志, 2020, 27(10): 1235-1241.
5. Slaughter M S, Rogers J G, Milano C A, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med, 2009, 361(23): 2241-2251.
6. Ng B C, Salamonsen R F, Gregory S D, et al. Application of multiobjective neural predictive control to biventricular assistance using dual rotary blood pumps. Biomed Signal Process Control, 2018, 39: 81-93.
7. Chow E, Farrar D J. Effects of left ventricular pressure reductions on right ventricular systolic performance. Am J Physiol Heart Circ Physiol, 1989, 257(6 Pt 2): H1878-85.
8. Moon M R, Castro L J, DeAnda A, et al. Right ventricular dynamics during left ventricular assistance in closed-chest dogs. Ann Thorac Surg, 1993, 56(1): 54-67.
9. Farrar D J, Chow E, Compton P G, et al. Effects of acute right ventricular ischemia on ventricular interactions during prosthetic left ventricular support. J Thorac Cardiovasc Surg, 1991, 102(4): 588-595.
10. Omoto T, Tanabe H, Laria P, et al. Right ventricular performance during left ventricular unloading conditions: the contribution of the right ventricular free wall. J Thorac Cardiovasc Surg, 2002, 50(1): 16-20.
11. Park C H, Nishimura K, Kitano M, et al. Right ventricular performance is impaired by full assist of left heart bypass: analysis of right ventricular performance against change in afterload in heart failure models. ASAIO J, 1994, 40(3): M303-M308.
12. Kitano M, Nishimura K, Hee P C, et al. Right ventricular function evaluated by volumetric analysis during left heart bypass in a canine model of postischemic cardiac dysfunction. J Thorac Cardiovasc Surg, 1995, 109(4): 796-803.
13. Daly R C, Chandrasekaran K, Cavarocchi N C, et al. Ischemia of the interventricular septum. A mechanism of right ventricular failure during mechanical left ventricular assist. J Thorac Cardiovasc Surg, 1992, 103(6): 1186-1191.
14. 杨新娟, 王秉臣, 崔炜. 慢性心力衰竭患者双心室收缩同步性与其结构研究. 中国心血管杂志, 2006, 11(4): 257-260.
15. Yoshioka D, Sakaguchi T, Saito S, et al. Predictor of early mortality for severe heart failure patients with left ventricular assist device implantation: significance of INTERMACS level and renal function. Circ J, 2012, 76(7): 1631-1638.
16. Aissaoui N, Morshuis M, Schoenbrodt M, et al. Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients. J Thorac Cardiovasc Surg, 2013, 146(1): 186-191.
17. Arakawa M, Nishimura T, Takewa Y, et al. Novel control system to prevent right ventricular failure induced by rotary blood pump. J Artif Organs, 2014, 17(2): 135-141.
18. 王芳群, 徐庆, 吴振海, 等. 基于左心辅助的血液循环系统的控制研究. 生物医学工程学杂志, 2016, 33(6): 1075-1083.
19. Suga H, Sagawa K. Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res, 1974, 35(1): 117-126.
20. Korakianitis T, Shi Y. Numerical simulation of cardiovascular dynamics with healthy and diseased heart valves. J Biomech, 2006, 39(11): 1964-1982.
21. Bozkurt S. Arterial pulsatility and aortic valve function under continuous flow left ventricular assist device support, continuous speed vs. varying speed pump assistance. Ann Biomed Eng, 2015, 43: 1727-1737.

Journal of Biomedical Engineering

Study on the synchronization of biventricular beats with the control mode of left ventricular assist device

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