Sensor-Based Physiologic Control Strategy for Biventricular Support with Rotary Blood Pumps.
Sensor-Based Physiologic Control Strategy for Biventricular Support with Rotary Blood Pumps.
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DOI：
10.1097/mat.0000000000000671
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Giridharan GA
中科院分区：
文献类型：
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作者：
Wang Y;Koenig SC;Wu Z;Slaughter MS;Giridharan GA
旋转双心室辅助装置（BiVAD）正在成为临床上接受的终末期双心室衰竭的治疗选择。为了提高 BiVAD 的疗效和安全性，我们提出了一种控制算法来实现维持左右平衡、恢复生理血流和防止心室抽吸的临床目标。控制算法由用于左心室辅助装置和右心室辅助装置（LVAD、RVAD）的两个比例积分控制器组成，以维持 LVAD (ΔPL) 和 RVAD (ΔPR) 上的泵压差，从而提供左右平衡和生理流量。为了防止心室抽吸，LVAD 和 RVAD 泵速差（ΔRPML、ΔRPMR）保持在用户定义的阈值之上。使用（1）正常和过度的ΔPL和/或ΔPR设定值，（2）肺血管或腔静脉阻力快速增加三倍，（3）从运动到休息的瞬态响应，以及（4）心室颤动，在计算机上测试了所提出算法的有效性和鲁棒性，用于轴向和离心流BiVAD。研究成功证明所提出的 BiVAD 算法实现了临床目标，但需要压力传感器连续测量 ΔPL 和 ΔPR。所提出的控制算法是独立于设备的，不需要对泵或流入/流出插管/移植物进行任何修改，并且可以直接应用于当前用于双心室支持的旋转血泵。
Rotary biventricular assist devices (BiVAD) are becoming a clinically accepted treatment option for end-stage biventricular failure. To improve BiVAD efficacy and safety, we propose a control algorithm to achieve the clinical objectives of maintaining left-right sided balance, restoring physiologic flows, and preventing ventricular suction. The control algorithm consists of two proportional-integral controllers for left and right ventricular assist devices (LVAD, RVAD) to maintain differential pump pressure across LVAD (ΔPL) and RVAD (ΔPR) to provide left-right balance and physiologic flow. To prevent ventricular suction, LVAD and RVAD pump speed differentials (ΔRPML, ΔRPMR) were maintained above user-defined thresholds. Efficacy and robustness of the proposed algorithm were tested in silico for axial and centrifugal flow BiVAD using (1) normal and excessive ΔPL and/or ΔPR setpoints, (2) rapid three-fold increase in pulmonary vascular or vena caval resistances, (3) transient responses from exercise to rest, and (4) ventricular fibrillation. The study successfully demonstrated that the proposed BiVAD algorithm achieved the clinical objectives, but required pressure sensors to continuously measure ΔPL and ΔPR. The proposed control algorithm is device independent, should not require any modifications to the pump or inflow/outflow cannulae/grafts, and may be directly applied to current rotary blood pumps for biventricular support.