Left Ventricle Load Impedance Control

by Apical VAD Can Help

Heart Recovery and Patient Perfusion
†Arabia M., †Colacino F., †Moscato F.
‡Piedimonte F., †Danieli G.
† University of Calabria, Mechanical Engineering Dept., Rende – Italy
‡ University of Rome “Tor Vergata” , Automation and Control Dept., Rome – Italy

UNIVERSITÀ DELLACALABRIA

Dipartimento di MECCANICA
 Aim
Mechanical Engineering Dept. – F. Moscato

This study is concerning with the

ESAO - October 5-8, 2005 - Bologna

dependence between LV load

impedance control by apical pulsatile
University of Calabria

VAD and consequent benefits.

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 Cardiovascular Model Features
Mechanical Engineering Dept. – F. Moscato

 RV & LV Non Linear Time Varying Elastance Model

ESAO - October 5-8, 2005 - Bologna

 Active Atria
 Noordergaaf Arterial Load Model
University of Calabria

 Guyton’s Venous Return Model

 No Bronchial Artery
 Automatic Circulatory Parameters Variation with
Feedback Loops: Ras, Rap, Rvs, Vusv

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Cardiovascular Model: Electric Analog

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 Pulsatile VAD Model
 Pusher Plate – Sac pump (pneumatic or electromechanic)
Stroke Volume up to 80 [ml]
Mechanical Engineering Dept. – F. Moscato

 Synchronized Counter Pulsation

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 Diaphragm always in contact with the Piston Head

 Active Controlled Filling
University of Calabria

 Rigid Inlet & Outlet Cannulas

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 VAD Ejection Phase
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
University of Calabria

 Piston pushes all the blood outside the chamber

 LVAD afterload sensitivity is not controlled
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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna

Physical
environment
Simulated
Arterial Load
VAD Filling Phase

 Qi _ VAD
Rcs *
Pˆlv  Pao *

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Pulsatile LVAD Filling Control Strategy

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
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How do we choose Ras*?  EWˆ PVA

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 LV and RV Pressure-Volume Loops for a case
study: LV contractility 34%, HR= 90 [bpm]
Left Ventricle Right Ventricle
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
University of Calabria

 VED= 189 [ml]  Mean Pap = 26 [mmHg]

 SV = 44.5 [ml]
 EF = 23%
 EW/PVA = 0.385
 MPao = 86.5 [mmHg]
 MPla = 17.5 [mmHg]
 Wall Stress = 108 [mmHg] 10/22
 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Initial Pathological Conditions
Cardiac Output and Venous Return Curves:

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Controlled LV Afterload Reduction

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Assisted Conditions
Cardiac Output and Venous Return Curves:

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Time Course of Mean Quantities

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Time Course of Mean Quantities

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 LV and RV Pressure-Volume Loops with LVAD
Left Ventricle Right Ventricle
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
University of Calabria

 VED= 189 [ml]  112 [ml]  Mean APP = 26 [mmHg]

 SV = 44.5 [ml]  62 [ml]  17.5 [mmHg]
 EF = 23%  56%  SV ↑
 EW/PVA = 0.385  0.730  EF ↑
 MAOP = 86.5 [mmHg]  102 [mmHg]
 MLAP = 17.5 [mmHg]  6 [mmHg]
 Wall Stress = 108 [mmHg]  48 [mmHg] 16/22
 EKF: Plv, Vlv, Emax estimation
 Measurements or estimates needed for system identification:
 Pvad, Fiso, QVAD,VED, EMIN
 Good results were achieved considering white measurement noise affecting
Mechanical Engineering Dept. – F. Moscato

Pvad and VED measurements (with variance = 10 [mmHg] and 10 [ml]

respectively)
ESAO - October 5-8, 2005 - Bologna

 Almost insensitive to relative errors of 50% on EMIN

University of Calabria

Err. ~10%

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna
Estimated PV Loop and Emax

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
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Estimated PV Loop (Preload Variations)

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
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Pressure
Flow
Pressure and Flow Waveforms

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 Conclusions

 Advantages
Mechanical Engineering Dept. – F. Moscato

 On-line monitoring of Heart Mechanics and Perfusion

ESAO - October 5-8, 2005 - Bologna

 Non Invasiveness – Estimation of PLV, VLV, Emax, QoLV

 No impact between Piston Head and Diaphragm
University of Calabria

 Disadvantages
 For very weak LV even reducing the afterload to 0 [mmHg]
might not be enough
 Pump chamber dimension
 Estimation of Emax is poorer when LV ejects into Aorta
 VED must be measured (VED estimation is a work in
progress)

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 University of Calabria
Mechanical Engineering Dept. – F. Moscato
ESAO - October 5-8, 2005 - Bologna

Thank You 

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