From the Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, Liaoning, China.
Department of Bioengineering, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY.
ASAIO J. 2018 May/Jun;64(3):338-350. doi: 10.1097/MAT.0000000000000671.
Rotary biventricular assist devices (BiVAD) are becoming a clinically accepted treatment option for end-stage biventricular failure. To improve BiVAD efficacy and safety, we propose a control algorithm to achieve the clinical objectives of maintaining left-right-sided balance, restoring physiologic flows, and preventing ventricular suction. The control algorithm consists of two proportional-integral (PI) controllers for left and right ventricular assist devices (LVAD and RVAD) to maintain differential pump pressure across LVAD (ΔPL) and RVAD (ΔPR) to provide left-right balance and physiologic flow. To prevent ventricular suction, LVAD and RVAD pump speed differentials (ΔRPML, ΔRPMR) were maintained above user-defined thresholds. Efficacy and robustness of the proposed algorithm were tested in silico for axial and centrifugal flow BiVAD using 1) normal and excessive ΔPL and/or ΔPR setpoints, 2) rapid threefold increase in pulmonary vascular or vena caval resistances, 3) transient responses from exercise to rest, and 4) ventricular fibrillation. The study successfully demonstrated that the proposed BiVAD algorithm achieved the clinical objectives but required pressure sensors to continuously measure ΔPL and ΔPR. The proposed control algorithm is device independent, should not require any modifications to the pump or inflow/outflow cannulae/grafts, and may be directly applied to current rotary blood pumps for biventricular support.
旋转双心室辅助装置（BiVAD）正成为治疗终末期双心室衰竭的一种临床可接受的治疗选择。为了提高 BiVAD 的疗效和安全性，我们提出了一种控制算法，以实现维持左右平衡、恢复生理流量和防止心室抽吸的临床目标。该控制算法由两个用于左心室辅助装置（LVAD）和右心室辅助装置（RVAD）的比例积分（PI）控制器组成，以维持 LVAD（ΔPL）和 RVAD（ΔPR）之间的压差，从而提供左右平衡和生理流量。为了防止心室抽吸，LVAD 和 RVAD 的泵速差（ΔRPML、ΔRPMR）保持在用户定义的阈值之上。使用 1）正常和过度 ΔPL 和/或 ΔPR 设定值、2）肺血管或腔静脉阻力的三倍快速增加、3）从运动到休息的瞬态响应和 4）心室颤动，对轴向和离心式血流 BiVAD 的拟议算法进行了计算机模拟测试。研究成功地证明了所提出的 BiVAD 算法实现了临床目标，但需要压力传感器来连续测量 ΔPL 和 ΔPR。所提出的控制算法是独立于设备的，不需要对泵或流入/流出导管/移植物进行任何修改，并且可以直接应用于当前的双心室旋转血液泵。
