Modeling of Virtual Mechanical Circulatory Hemodynamics for Biventricular Heart Failure Support
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Cardiovascular Engineering and Technology ( 2020) https://doi.org/10.1007/s13239-020-00501-y
Original Article
Modeling of Virtual Mechanical Circulatory Hemodynamics for Biventricular Heart Failure Support DENNIS W. HORVATH,1 ANTHONY R. POLAKOWSKI,2 CHRISTINE FLICK,2 KIYOTAKA FUKAMACHI,2 DAVID J. HORVATH,1 and JAMSHID H. KARIMOV 2 1
R1 Engineering LLC, Euclid, OH, USA; and 2Department of Biomedical Engineering/ND20, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA (Received 26 May 2020; accepted 5 November 2020) Associate Editor Scott C. Corbett oversaw the review of this article.
Abstract Objective—In this study, a mechanical circulatory support simulation tool was used to investigate the application of a unique device with two centrifugal pumps and one motor for the biventricular assist device (BVAD) support application. Several conditions—including a range of combined left and right systolic heart failure severities, aortic and pulmonary valve regurgitation, and combinations of high and low systemic and pulmonary vascular resistances—were considered in the simulation matrix. Relative advantages and limitations of using the device in BVAD applications are discussed. Methods—The simulated BVAD pump was based on the Cleveland Clinic pediatric continuous-flow total artificial heart (P-CFTAH), which is currently under development. Different combined disease states (n = 10) were evaluated to model the interaction with the BVAD, considering combinations of normal heart, moderate failure and severe systolic failure of the left and right ventricles, regurgitation of the aortic and pulmonary valves and combinations of vascular resistance. The virtual mock loop simulation tool (MATLAB; MathWorks, Natick, MA) simulates the hemodynamics at the pump ports using a lumped-parameter model for systemic/pulmonary circulation characteristic inputs (values for impedance, systolic and diastolic ventricular compliance, beat rate, and blood volume), and characteristics of the cardiac chambers and valves. Results—Simulation results showed that this single-pump BVAD can provide regulated support of up to 5 L/min over a range of combined heart failure states and is suitable for smaller adult and pediatric support. However, good selfregulation of the atrial pressure difference was not maintained with the introduction of aortic valve regurgitation or
Address correspondence to Jamshid H. Karimov, Department of Biomedical Engineering/ND20, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA. Electronic mail: [email protected]
high systemic vascular resistance when combined with low pulmonary vascular resistance. Conclusions—This initial in silico study demonstrated that use of the P-CFTAH as a BVAD supports cardiac output and arterial pressure in biventricular heart failure conditions. A simi
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