In‐Series Versus In‐Parallel Mechanical Circulatory Support for the Right Heart: A Simulation Study

Abstract

Right heart failure (RHF) is a serious health issue with increasing incidence and high mortality. Right ventricular assist devices (RVADs) have been used to support the end-stage failing right ventricle (RV). Current RVADs operate in parallel with native RV, which alter blood flow pattern and increase RV afterload, associated with high tension in cardiac muscles and long-term valve complications. We are developing an in-series RVAD for better RV unloading. This article presents a mathematical model to compare the effects of RV unloading and hemodynamic restoration on an overloaded or failing RV. The model was used to simulate both in-series (sRVAD) and in-parallel (pRVAD) (right atrium-pulmonary artery cannulation) support for severe RHF. The results demonstrated that sRVAD more effectively unloads the RV and restores the balance between RV oxygen supply and demand in RHF patients. In comparison to simulated pRVAD and published clinical and in silico studies, the sRVAD was able to provide comparable restoration of key hemodynamic parameters and demonstrated superior afterload and volume reduction. This study concluded that in-series support was able to produce effective afterload reduction and preserve the valve functionality and native blood flow pattern, eliminating complications associated with in-parallel support.

An analytic method to investigate hemodynamics of the cardiovascular system – single ventricular system

“…The simulation based on LPM greatly reduced computational expense compared to 3-dimensional computational fluid dynamics 1 and can produce hemodynamics in agreement with clinical data. 2,3…”

“…The simulation based on LPM greatly reduced computational expense compared to 3-dimensional computational fluid dynamics 1 and can produce hemodynamics in agreement with clinical data. 2,3 LPMs are widely used to investigate various aspects of the cardiovascular system, including mechanisms related to pathophysiology of disease, effects of certain surgeries and hemodynamic effects of mechanical circulatory support (MCS). [4][5][6][7] Most of applications are related to responses to changes in parameters or structures of model.…”