Feasibility of Pump Speed Modulation for Restoring Vascular Pulsatility with Rotary Blood Pumps
Feasibility of Pump Speed Modulation for Restoring Vascular Pulsatility with Rotary Blood Pumps
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DOI：
10.1097/mat.0000000000000262
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发表时间：
2015-09-01
期刊：
影响因子：
4.2
通讯作者：
Giridharan, Guruprasad A.
中科院分区：
文献类型：
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作者：
Ising, Mickey S.;Sobieski, Michael A.;Giridharan, Guruprasad A.
连续流（CF）左心室辅助装置（LVAD）降低了血管压力脉动性，这可能与临床报告的不良事件相关，包括胃肠道出血、主动脉瓣关闭不全和出血性卒中。在模拟血流环路和缺血性心力衰竭（IHF）牛模型中，通过量化作为平均泵速、调制幅度和时间函数的血流动力学性能，评价了旨在增强主动脉搏动的三种候选CF LVAD泵速调制算法。异步和同步交配（心脏收缩期间高每分钟转数[RPM]，心脏舒张期间低RPM）和反搏（心脏收缩期间低RPM，心脏舒张期间高RPM）针对定义的调制幅度测试算法（+/- 300、+/- 500、+/- 800和+/-1，100 RPM）和频率（18.75、37.5和60次/分钟），低（2，900 RPM）和高（3，200 RPM）平均LVAD速度。在模拟血流环路模型中，异步、同步交搏和同步反搏算法均增加了脉压（P = 931%、210%和98%），并减少了左心室外功（LVEW = 20%、22%和16%）。在IHF牛模型中观察到血管脉动性（1，142%）和LVEW（40%）的类似改善。异步调制产生最大的血管脉动性，其优点是不需要传感器来定时泵速调制，便于潜在的临床实施。
Continuous flow (CF) left ventricular assist devices (LVAD) diminish vascular pressure pulsatility, which may be associated with clinically reported adverse events including gastrointestinal bleeding, aortic valve insufficiency, and hemorrhagic stroke. Three candidate CF LVAD pump speed modulation algorithms designed to augment aortic pulsatility were evaluated in mock flow loop and ischemic heart failure (IHF) bovine models by quantifying hemodynamic performance as a function of mean pump speed, modulation amplitude, and timing. Asynchronous and synchronous copulsation (high revolutions per minute [RPM] during systole, low RPM during diastole) and counterpulsation (low RPM during systole, high RPM during diastole) algorithms were tested for defined modulation amplitudes (+/- 300, +/- 500, +/- 800, and +/- 1,100 RPM) and frequencies (18.75, 37.5, and 60 cycles/minute) at low (2,900 RPM) and high (3,200 RPM) mean LVAD speeds. In the mock flow loop model, asynchronous, synchronous copulsation, and synchronous counterpulsation algorithms each increased pulse pressure (P = 931%, 210%, and 98% and reduced left ventricular external work (LVEW = 20%, 22%, 16%). Similar improvements in vascular pulsatility (1,142%) and LVEW (40%) were observed in the IHF bovine model. Asynchronous modulation produces the largest vascular pulsatility with the advantage of not requiring sensor(s) for timing pump speed modulation, facilitating potential clinical implementation.