Ferrari G, De Lazzari C, Mimmo R, Tosti G, Ambrosi D, Gorczynska K
Institute of Biomedical Technologies, CNR, Roma - Italy.
Int J Artif Organs. 1998 Jan;21(1):26-36.
The clinical use of heart assist devices for heart recovery, implies the problem of their in vitro testing and training to use. In a mock circulatory system developed to this aim, the main problem is reproducing interaction among the device, the ventricle and the circulatory network. This can be analysed by the position, on the p-v plane, of the working point defined by the intersection between end systolic ventricular (ESPVR) and arterial elastance lines. The system developed on this basis, connectable to mono- and biventricular parallel assist devices, was a closed loop model including systemic and pulmonary circulation. The arterial trees were reproduced by two windkessels with adjustable peripheral resistance, and the Starling's law of the heart by a variable elastance model. The software controls and monitors circulatory parameters and variables. Results showed the behavior of the system with preload or afterload changes. Further, the reproduction of physiological, pathological (obtained by modifying slope and volume intercept of the ESPVR line) and LVAD assisted circulatory conditions was shown. The assistance effect was underlined by the changes in the ventricular work cycle and in hemodynamics variables. The evaluation of the effect of device control strategy on the ventricle and its energetics (on p-v plane) were among the main characteristics of this system, which ought to be further improved to test devices such as the IABP, which requires a different aortic model.
心脏辅助装置用于心脏恢复的临床应用,意味着其体外测试和使用培训的问题。在为此目的而开发的模拟循环系统中,主要问题是再现装置、心室和循环网络之间的相互作用。这可以通过在压力-容积平面上,由收缩末期心室压力-容积关系(ESPVR)线与动脉弹性线的交点所定义的工作点的位置来分析。在此基础上开发的系统,可连接到单心室和双心室并联辅助装置,是一个包括体循环和肺循环的闭环模型。动脉树由两个外周阻力可调的风箱再现,心脏的斯塔林定律由可变弹性模型再现。该软件控制和监测循环参数及变量。结果显示了系统在预负荷或后负荷变化时的行为。此外,还展示了生理、病理(通过修改ESPVR线的斜率和容积截距获得)以及左心室辅助装置辅助循环条件的再现情况。心室工作周期和血流动力学变量的变化突出了辅助效果。评估装置控制策略对心室及其能量学(在压力-容积平面上)的影响是该系统的主要特点之一,该系统应进一步改进以测试如主动脉内球囊反搏(IABP)等需要不同主动脉模型的装置。