Simulation and enhancement of a cardiovascular device test rig

Stevens

et al. 2015

Artificial Organs

Implantable left ventricular assist devices (LVADs) have been adapted clinically for right-sided mechanical circulatory support (RVAD). Previous studies on RVAD support have established the benefits of outflow cannula restriction and rotational speed reduction, and recent literature has focused on assessing either the degree of outflow cannula restriction required to simulate left-sided afterload, or the limitation of RVAD rotational speeds. Anecdotally, the utility of outflow cannula restriction has been questioned, with suggestion that banding may be unnecessary and may be replaced simply by varying the outflow conduit length. Furthermore, many patients have a high pulmonary vascular resistance (PVR) at the time of ventricular assist device (VAD) insertion that reduces with pulmonary vascular bed remodeling. It is therefore important to assess the potential changes in flow through an RVAD as PVR changes. In this in vitro study, we observed the use of dual HeartWare HVAD devices (HeartWare Inc., Framingham, MA, USA) in biventricular support (BiVAD) configuration. We assessed the pumps' ability to maintain hemodynamic stability with and without banding; and with varying outflow cannulae length (20, 40, and 60 cm). Increased length of the outflow conduit was found to produce significantly increased afterload to the device, but this was not found to be necessary to maintain the device within the manufacturer's recommended operational parameters under a simulated normal physiological setting of mild and severe right ventricular (RV) failure. We hypothesize that 40 cm of outflow conduit, laid down along the diaphragm and then up over the RV to reach the pulmonary trunk, will generate sufficient resistance to maintain normal pump function.

Section: Methodsmentioning

confidence: 99%

Banding the Right Ventricular Assist Device Outflow Conduit: Is It Really Necessary With Current Devices?

Stevens

et al. 2015

Artificial Organs

“…A physical five-element Windkessel MCL including systemic and pulmonary circulations was used for this study (31,32). Atrial and ventricular chambers were represented by 40 and 50 mm clear, vertical polyvinyl chloride pipes with tee sections connecting the inflow, outflow, and heart chamber.…”

Section: Mock Circulation Loopmentioning

confidence: 99%

Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

Pearcy

Timms³

2013

Artificial Organs

Right heart dysfunction is one of the most serious complications following implantation of a left ventricular assist device, often leading to the requirement for short- or long-term right ventricular assist device (RVAD) support. The inflow cannulation site induces major hemodynamic changes and so there is a need to optimize the site used depending on the patient's condition. Therefore, this study evaluated and compared the hemodynamic influence of right atrial cannulation (RAC) and right ventricular cannulation (RVC) inflow sites. An in vitro variable heart failure mock circulation loop was used to compare RAC and RVC in mild and severe biventricular heart failure (BHF) conditions. In the severe BHF condition, higher ventricular ejection fraction (RAC: 13.6%, RVC: 32.7%) and thus improved heart chamber and RVAD washout were observed with RVC, which suggested this strategy might be preferable for long-term support (i.e., bridge-to-transplant or destination therapy) to reduce the risk of thrombus formation. In the mild BHF condition, higher pulmonary valve flow (RAC: 3.33 L/min, RVC: 1.97 L/min) and lower right ventricular stroke work (RAC: 0.10 W, RVC: 0.13 W) and volumes were recorded with RAC. These results indicate an improved potential for myocardial recovery, thus RAC should be chosen in this condition. This in vitro study suggests that RVAD inflow cannulation site should be chosen on a patient-specific basis with a view to the support strategy to promote myocardial recovery or reduce the risk of long-term complications.

“…To assist in the development and ensure improved haemodynamic results, a mathematical simulation was used to determine the physical properties of the system such as pipe dimensions and input pressures [5]. In both simulation and bench top MCL; cardiac chambers were connected to systemic and pulmonary circuits for representation of the complete cardiovascular system.…”

Section: A Mock Circulation Loop Descriptionmentioning

confidence: 99%

Haemodynamic modeling of the cardiovascular system using mock circulation loops to test cardiovascular devices

Timms

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

Stevens

2011

Comprehensive testing and evaluation of cardiovascular device function and performance is required prior to clinical implementation. Initial proof of concept investigations are conducted within in-vitro mock circulation loops, before proof of principle is demonstrated via in-vivo animal testing. To facilitate the rapid transition of cardiovascular devices through this development period, a testing apparatus was developed that closely models the natural human cardiovascular system haemodynamics. This mock circulation system accurately replicates cardiac function, coupled to systemic and pulmonary circulations. The physiological response produced by a number of clinical cardiovascular conditions can be actively controlled by variable parameters such as vascular resistance, arterial/venous compliance, ventricle contractility, heart rate, and heart /vascular volumes, while anatomical variations such as valve regurgitation and septal defects can be included. Auto-regulation of these parameters was attempted to reproduce the Frank-Starling mechanism, baroreceptor reflex, skeletal muscle pump, and postural changes. Steady state validation of loop performance was achieved by replicating the progression of a patient's clinical haemodynamics from heart failure, through VAD support, to heart transplantation. The system has been used to evaluate pulsatile and non-pulsatile ventricular assist devices, counter pulsation devices, non-invasive cardiac output monitors and cardiovascular stents. The interaction of these devices with the cardiovascular system was also investigated with regards to physiological control strategies and cannula placement. The system is a valuable tool for the accelerated progression of cardiovascular device development.