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Gwosch T, Magkoutas K, Kaiser D, Schmid Daners M. Performance and Reliable Operation of Physiological Controllers Under Various Cardiovascular Models: In Silico and In Vitro Study. ASAIO J 2024:00002480-990000000-00421. [PMID: 38373197 DOI: 10.1097/mat.0000000000002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
The evaluation of control schemes for left ventricular assist devices (LVADs) requires the utilization of an appropriate model of the human cardiovascular system. Given that different patients and experimental data yield varying performance of the cardiovascular models (CVMs) and their respective parameters, it becomes crucial to assess the reliable operation of controllers. This study aims to assess the performance and reliability of various LVAD controllers using two state-of-the-art CVMs, with a specific focus on the impact of interpatient variability. Extreme test cases were employed for evaluation, incorporating both in silico and in vitro experiments. The differences observed in response between the studied CVMs can be attributed to variations in their structures and parameters. Specifically, the model with smaller compartments exhibits higher overload rates, whereas the other model demonstrates increased sensitivity to changes in preload and afterload, resulting in more frequent suction events (34.2% vs. 8.5% for constant speed mode). These findings along with the varying response of the tested controllers highlight the influence of the selected CVM emphasizing the need to test each LVAD controller with multiple CVMs or, at least, a range of parameter sets. This approach ensures sufficient evaluation of the controller's efficacy in addressing interpatient variability.
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Affiliation(s)
- Thomas Gwosch
- From the Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | | | - David Kaiser
- From the Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
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Magkoutas K, Nunes Rossato L, Heim M, Schmid Daners M. Genetic algorithm-based optimization framework for control parameters of ventricular assist devices. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Magkoutas K, Chala N, Wu X, Poulikakos D, Mazza E, Meboldt M, Falk V, Ferrari A, Giampietro C, Schmid Daners M. In-vitro investigation of endothelial monolayer retention on an inflow VAD cannula inside a beating heart phantom. Biomater Adv 2023; 152:213485. [PMID: 37302211 DOI: 10.1016/j.bioadv.2023.213485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Abstract
Ventricular assist devices (VADs) provide an alternative solution to heart transplantation for patients with end-stage heart failure. Insufficient hemocompatibility of VAD components can result in severe adverse events, such as thromboembolic stroke, and readmissions. To enhance VAD hemocompatibility, and avoid thrombus formation, surface modification techniques and endothelialization strategies are employed. In this work, a free form patterning topography is selected to facilitate the endothelialization of the outer surface of the inflow cannula (IC) of a commercial VAD. An endothelialization protocol for convoluted surfaces such as the IC is produced, and the retainment of the endothelial cell (EC) monolayer is evaluated. To allow this evaluation, a dedicated experimental setup is developed to simulate realistic flow phenomena inside an artificial, beating heart phantom with a VAD implanted on its apex. The procedural steps of mounting the system result to the impairment of the EC monolayer, which is further compromised by the developed flow and pressure conditions, as well as by the contact with the moving inner structures of the heart phantom. Importantly, the EC monolayer is better maintained in the lower part of the IC, which is more susceptible to thrombus formation and may therefore aid in minimizing the hemocompatibility related adverse events after the VAD implantation.
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Affiliation(s)
- Konstantinos Magkoutas
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nafsika Chala
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Xi Wu
- Experimental Continuum Mechanics, Department of Mechanical and Process Engineering, Institute for Mechanical Systems, ETH Zurich, Zurich, Switzerland
| | - Dimos Poulikakos
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Edoardo Mazza
- Experimental Continuum Mechanics, Department of Mechanical and Process Engineering, Institute for Mechanical Systems, ETH Zurich, Zurich, Switzerland; Experimental Continuum Mechanics, EMPA, Dubendorf, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, 13353 Berlin, Germany; Clinic for Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany; Department of Health Sciences and Technology, ETH Zurich, 8093 Zurich, Switzerland
| | - Aldo Ferrari
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Costanza Giampietro
- Experimental Continuum Mechanics, Department of Mechanical and Process Engineering, Institute for Mechanical Systems, ETH Zurich, Zurich, Switzerland; Experimental Continuum Mechanics, EMPA, Dubendorf, Switzerland.
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
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Magkoutas K, Weisskopf M, Falk V, Emmert MY, Meboldt M, Cesarovic N, Schmid Daners M. Continuous Monitoring of Blood Pressure and Vascular Hemodynamic Properties With Miniature Extravascular Hall-Based Magnetic Sensor. JACC Basic Transl Sci 2023; 8:546-564. [PMID: 37325404 PMCID: PMC10264706 DOI: 10.1016/j.jacbts.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
Continuous measurement of vascular and hemodynamic parameters could improve monitoring of disease progression and enable timely clinical decision making and therapy surveillance in patients suffering from cardiovascular diseases. However, no reliable extravascular implantable sensor technology is currently available. Here, we report the design, characterization, and validation of an extravascular, magnetic flux sensing device capable of capturing the waveforms of the arterial wall diameter, arterial circumferential strain, and arterial pressure without restricting the arterial wall. The implantable sensing device, comprising a magnet and a magnetic flux sensing assembly, both encapsulated in biocompatible structures, has shown to be robust, with temperature and cyclic-loading stability. Continuous and accurate monitoring of arterial blood pressure and vascular properties was demonstrated with the proposed sensor in vitro with a silicone artery model and validated in vivo in a porcine model mimicking physiologic and pathologic hemodynamic conditions. The captured waveforms were further used to deduce the respiration frequency, the duration of the cardiac systolic phase, and the pulse wave velocity. The findings of this study not only suggest that the proposed sensing technology is a promising platform for accurate monitoring of arterial blood pressure and vascular properties, but also highlight the necessary changes in the technology and the implantation procedure to allow the translation of the sensing device in the clinical setting.
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Affiliation(s)
- Konstantinos Magkoutas
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Translational Cardiovascular Technologies, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Translational Cardiovascular Technologies, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
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Kourouklis AP, Wu X, Geyer RC, Exarchos V, Nazari T, Kaemmel J, Magkoutas K, Daners MS, Weisskopf M, Maini L, Roman C, Iske J, Pappas GA, Chen MJ, Smid C, Unbehaun A, Meyer A, Emmert M, Ferrari A, Schuett C, Poulikakos D, Mazza E, Falk V, Cesarovic N. Building an interdisciplinary program of cardiovascular research at the Swiss Federal Institute of Technology– the ETHeart story. iScience 2022; 25:105157. [PMID: 36185369 PMCID: PMC9520014 DOI: 10.1016/j.isci.2022.105157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In this backstory, researchers from Swiss Federal Institute of Technology (ETH Zurich) who initiated an interdisciplinary program to generate innovative solutions for different cardiovascular diseases, such as myocardial infarction, valvular replacement, and movement-based rehabilitation therapy, discuss the benefits and challenges of interdisciplinary research.
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Magkoutas K, Arm P, Meboldt M, Schmid Daners M. Physiologic Data-Driven Iterative Learning Control for Left Ventricular Assist Devices. Front Cardiovasc Med 2022; 9:922387. [PMID: 35911509 PMCID: PMC9326058 DOI: 10.3389/fcvm.2022.922387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Continuous flow ventricular assist devices (cfVADs) constitute a viable and increasingly used therapy for end-stage heart failure patients. However, they are still operating at a fixed-speed mode that precludes physiological cfVAD response and it is often related to adverse events of cfVAD therapy. To ameliorate this, various physiological controllers have been proposed, however, the majority of these controllers do not account for the lack of pulsatility in the cfVAD operation, which is supposed to be beneficial for the physiological function of the cardiovascular system. In this study, we present a physiological data-driven iterative learning controller (PDD-ILC) that accurately tracks predefined pump flow trajectories, aiming to achieve physiological, pulsatile, and treatment-driven response of cfVADs. The controller has been extensively tested in an in-silico environment under various physiological conditions, and compared with a physiologic pump flow proportional-integral-derivative controller (PF-PIDC) developed in this study as well as the constant speed (CS) control that is the current state of the art in clinical practice. Additionally, two treatment objectives were investigated to achieve pulsatility maximization and left ventricular stroke work (LVSW) minimization by implementing copulsation and counterpulsation pump modes, respectively. Under all experimental conditions, the PDD-ILC as well as the PF-PIDC demonstrated highly accurate tracking of the reference pump flow trajectories, outperforming existing model-based iterative learning control approaches. Additionally, the developed controllers achieved the predefined treatment objectives and resulted in improved hemodynamics and preload sensitivities compared to the CS support.
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Affiliation(s)
| | | | | | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
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Petersdorff-Campen KV, Dupuch MA, Magkoutas K, Meboldt M, Hierold C, Schmid Daners M. Pressure and Bernoulli-based Flow Measurement via a Tapered Inflow VAD Cannula. IEEE Trans Biomed Eng 2021; 69:1620-1629. [PMID: 34727020 DOI: 10.1109/tbme.2021.3123983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Currently available ventricular assist devices provide continuous flow and do not adapt to the changing needs of patients. Physiological control algorithms have been proposed that adapt the pump speed based on the left ventricular pressure. However, so far, no clinically used pump can acquire this pressure. Therefore, for the validation of physiological control concepts in vivo, a system that can continuously and accurately provide the left ventricular pressure signal is needed. METHODS We demonstrate the integration of two pressure sensors into a tapered inflow cannula compatible with the HeartMate 3 (HM3) ventricular assist device. Selective laser melting was used to incorporate functional elements with a small footprint and therefore retain the geometry, function and implantability of the original cannula. The system was tested on a hybrid mock circulation system. Static and simulated physiological flow and pressure profiles were used to evaluate the combined pressure and flow sensing capabilities of the modified cannula. CONCLUSION The cannula prototypes enabled continuous pressure measurements at two points of their inner wall in the range of 100 and 200 mmHg. The developed, Bernoulli-based, two sensor model improved the accuracy of the measured simulated left ventricular pressure by eliminating the influence of flow inside the cannula. This method reduced the flow induced pressure uncertainty from up to 7.6 mmHg in single sensor measurements to 0.3 mmHg. Additionally, the two-sensor system and model enable the measurement of the blood flow through the pump with an accuracy of 0.140.04 L/min, without dedicated flow sensors.
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Petrou A, Kanakis M, Magkoutas K, de Vries B, Meboldt M, Daners MS. Cardiac Output Estimation: Online Implementation for Left Ventricular Assist Device Support. IEEE Trans Biomed Eng 2021; 68:1990-1998. [PMID: 33338010 DOI: 10.1109/tbme.2020.3045879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We present a novel pipeline that consists of various algorithms for the estimation of the cardiac output (CO) during ventricular assist devices (VADs) support using a single pump inlet pressure (PIP) sensor as well as pump intrinsic signals. METHODS A machine learning (ML) model was constructed for the prediction of the aortic valve opening status. When a closed aortic valve is detected, the estimated CO equals the estimated pump flow. Otherwise, the estimated CO equals the sum of the estimated pump flow and the aortic valve flow, estimated via a Kalman-filter approach. Both the pathophysiological conditions and the pump speed of an in-vitro test bench were adjusted in various combinations to evaluate the performance of the pipeline, as well as the individual estimators. RESULTS The ML model yielded a Matthews correlation coefficient of 0.771, a sensitivity of 0.913 and a specificity of 0.871. An overall CO root mean square error (RMSE) of 0.69 L/min was achieved. Replacing the pump flow and aortic pressure estimators with sensors would decrease the RMSE below 0.5 L/min. CONCLUSION The performance of the proposed pipeline is considered the state of the art for VADs with an integrated PIP sensor. The effect of the individual estimators on the overall performance of the pipeline was thoroughly investigated and their limitations were identified for future research. SIGNIFICANCE The clinical application of the proposed solution could provide the clinicians with essential information about the interaction between the patient's heart and the VAD to further improve the VAD therapy.
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Dual SA, Llerena Zambrano B, Sündermann S, Cesarovic N, Kron M, Magkoutas K, Hengsteler J, Falk V, Starck C, Meboldt M, Vörös J, Schmid Daners M. Continuous Heart Volume Monitoring by Fully Implantable Soft Strain Sensor. Adv Healthc Mater 2020; 9:e2000855. [PMID: 32893478 DOI: 10.1002/adhm.202000855] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Cardiothoracic open-heart surgery has revolutionized the treatment of cardiovascular disease, the leading cause of death worldwide. After the surgery, hemodynamic and volume management can be complicated, for example in case of vasoplegia after endocarditis. Timely treatment is crucial for outcomes. Currently, treatment decisions are made based on heart volume, which needs to be measured manually by the clinician each time using ultrasound. Alternatively, implantable sensors offer a real-time window into the dynamic function of our body. Here it is shown that a soft flexible sensor, made with biocompatible materials, implanted on the surface of the heart, can provide continuous information of the heart volume after surgery. The sensor works robustly for a period of two days on a tensile machine. The accuracy of measuring heart volume is improved compared to the clinical gold standard in vivo, with an error of 7.1 mL for the strain sensor versus impedance and 14.0 mL versus ultrasound. Implanting such a sensor would provide essential, continuous information on heart volume in the critical time following the surgery, allowing early identification of complications, facilitating treatment, and hence potentially improving patient outcome.
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Affiliation(s)
- Seraina A. Dual
- Product Development Group Zurich ETH Zurich Tannenstrasse 3 Zurich 8092 Switzerland
- Cardiothoracic Surgery Stanford University Stanford CA 94305‐5101 USA
| | - Byron Llerena Zambrano
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
| | - Simon Sündermann
- DZHK (German Center for Cardiovascular Research) Partner Site Berlin 10785 Berlin Germany
- Department of Cardiovascular Surgery Charité—Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin Germany
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Augustenburger Pl. 1 13353 Berlin Germany
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Augustenburger Pl. 1 13353 Berlin Germany
- Department of Health Sciences and Technology Tannenstrasse 3 Zürich 8092 Switzerland
- Division for Surgical Research University Hospital Zurich and University of Zurich Rämistrasse 100 Zürich 8091 Switzerland
| | - Mareike Kron
- Division for Surgical Research University Hospital Zurich and University of Zurich Rämistrasse 100 Zürich 8091 Switzerland
| | | | - Julian Hengsteler
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
| | - Volkmar Falk
- DZHK (German Center for Cardiovascular Research) Partner Site Berlin 10785 Berlin Germany
- Department of Cardiovascular Surgery Charité—Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin Germany
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Augustenburger Pl. 1 13353 Berlin Germany
- Department of Health Sciences and Technology Tannenstrasse 3 Zürich 8092 Switzerland
| | - Christoph Starck
- DZHK (German Center for Cardiovascular Research) Partner Site Berlin 10785 Berlin Germany
| | - Mirko Meboldt
- Product Development Group Zurich ETH Zurich Tannenstrasse 3 Zurich 8092 Switzerland
| | - János Vörös
- Laboratory of Biosensors and Bioelectronics ETH Zurich Gloriastrasse 35 Zurich 8092 Switzerland
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Magkoutas K, Rebholz M, Sündermann S, Alogna A, Faragli A, Falk V, Meboldt M, Schmid Daners M. Control of ventricular unloading using an electrocardiogram-synchronized pulsatile ventricular assist device under high stroke ratios. Artif Organs 2020; 44:E394-E405. [PMID: 32321193 DOI: 10.1111/aor.13711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 01/17/2023]
Abstract
Pulsatile ventricular assist devices (pVADs) yield a blood flow that imitates the pulsatile flow of the heart and, therefore, could diminish the adverse events related to the continuous flow provided by the ventricular assist devices that are commonly used. However, their intrinsic characteristics of larger size and higher weight set a burden to their implantation, that along with the frequent mechanical failures and thrombosis events, reduce the usage of pVADs in the clinical environment. In this study, we investigated the possibility to reduce the pump size by using high pump stroke ratios while maintaining the ability to control the hemodynamics of the cardiovascular system (CVS). In vitro and in vivo experiments were conducted with a custom pVAD implemented on a hybrid mock circulation system and in five sheep, respectively. The actuation of the pVAD was synchronized with the heartbeat. Variations of the pump stroke ratio, time delay between the pump stroke and the heart stroke, as well as duration of the pump systole in respect to the total cardiac cycle duration were used to evaluate the effects of various pump settings on the hemodynamics of the CVS. The results suggest that by varying the operating settings of the pVAD, a pulsatile flow that provides physiological hemodynamic parameters, as well as a control over the hemodynamic parameters, can be achieved. Additionally, by employing high pump stroke ratios, the size of the pVAD can be significantly reduced; however, at those high pump stroke ratios, the effect of the other pump parameters diminishes.
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Affiliation(s)
- Konstantinos Magkoutas
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Mathias Rebholz
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Simon Sündermann
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Alessio Alogna
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
| | - Alessandro Faragli
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
| | - Volkmar Falk
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
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