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

A Multi-objective Physiological Control for Continuous Flow Left Ventricular Assist Devices: Comparison of Estimator versus Sensor-based Feedback. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023;2023:1-5. [PMID: 38082905 DOI: 10.1109/embc40787.2023.10340974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Left Ventricular Assist Devices have been successfully used for the treatment of Congestive Heart failure in patients who are not eligible for heart transplantation. This paper describes the implementation and comparison of the performance of a pressure sensor-based feedback controller. The strategies were tested on a mock loop of the systemic circulation. The results show that the use of pressure sensors generated a more accurate response of the controller compared to the use of estimators.Clinical Relevance- The study describes the integration of a LVAD physiological controller to a dynamic wireless monitoring system.

A Non-Invasive Physiological Control System of a Rotary Blood Pump Based on Preload Sensitivity: Use of Frank-Starling-Like Mechanism

Implanting rotary blood pumps (RBPs) has become the principal treatment for patients suffering from severe heart failure. There are still many challenges to address for RBP control systems. These problems include meeting the patient's physiological perfusion, eliminating postoperative complications, as well as debugging the patient's physiological control system (automatically and indiscriminately). This paper proposes a non-invasive adaptive control system based on the Frank-Starling-like mechanism (NAC-FSL) to solve these problems. This control system uses the motor speed of the rotary blood pump as the only input variable, and the pump flow was estimated by the motor speed for achieving non-invasive detection. Simultaneously, a cardiovascular reference model was developed to provide an appropriate real-time preload for heart failure patients. The Frank-Starling-like control baseline was tracked to obtain the desired reference average pump flow by using the preload. Avoiding suction was done by adopting the control baseline (CLn), which included a flat slope under a high preload. Moreover, the NAC-FSL system could potentially unload the left ventricle and provide a higher pump flow with a smaller error during the exercise state, as compared to the CSC system. Finally, the K value indicating the preload sensitivity in the NAC-FSL controller was optimized to meet the perfusion needs according to the hemodynamic parameters.

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

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.