Asymmetric speed modulation of a rotary blood pump affects ventricular unloading
Asymmetric speed modulation of a rotary blood pump affects ventricular unloading
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DOI：
10.1093/ejcts/ezs299
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发表时间：
2013-02-01
影响因子：
3.4
通讯作者：
Vandenberghe, Stijn
中科院分区：
文献类型：
--
作者：
Pirbodaghi, Tohid;Weber, Alberto;Vandenberghe, Stijn
目的：在各种临床应用中，从心肺机中的短期使用到衰竭心脏的长期支持，以恒定速度运行的旋转血泵（RBP）通常用于心脏的机械支持。其操作范围由抽吸和返流事件界定，对心脏工作负荷的控制有限。本研究探讨是否不同的收缩/舒张支持的比例是有利的，在一个恒定的速度operation.METHODS：为了有效地控制对心脏的负荷，本研究旨在开发一种脉动控制算法的旋转泵，调查泵的速度调制在收缩期和舒张期对左心室卸载的影响。通过左胸廓切开术将带有改良控制器的CentriMag（TM）RBP植入4只绵羊体内，并从心室尖部至降主动脉插管。为了调节与心跳同步的泵速，定制的实时软件检测心电图的QRS波群，并在收缩期和舒张期控制泵速。四个不同的速度调制相同的平均速度，但不同的收缩和舒张速度与基线和恒速支持进行了比较。左心室（LV）的压力和容量，冠状动脉流量和泵流量进行了分析，以检查泵的速度modulation.RESULTS的影响：脉动设置减少心脏工作负荷的64%的基线和72%的恒定速度值。最大卸载是在最高速度和高脉冲幅度下获得的。搏动模式下的舒张末期容积为基线值的85%至94%，恒定速度值的96%至107%。因此，可以调节心脏上的机械负荷以提供可导致心肌恢复的保证。较高的泵速度在收缩期的结果在增加的脉搏压力高达140%相比，恒定的speeds.Conclusions：本研究是一个初步的步骤，更准确的速度调制的RBPs优化心脏负荷控制。为了开发未来的控制算法，值得考虑的概念是，在收缩期期间的高速对LV具有最大的卸载效果，并且在收缩期期间的高速增加脉压。
OBJECTIVES: Rotary blood pumps (RBPs) running at a constant speed are routinely used for the mechanical support of the heart in various clinical applications, from short-term use in heart-lung machines to long-term support of a failing heart. Their operating range is delineated by suction and regurgitation events, leaving limited control on the cardiac workload. This study investigates whether different ratios of systolic/diastolic support are advantageous over a constant-speed operation.METHODS: In order to effectively control the load on the heart, this study aimed at developing a pulsatile control algorithm for rotary pumps to investigate the impact of pump speed modulation during systole and diastole on the left ventricle unloading. The CentriMag (TM) RBP with a modified controller was implanted in four sheep via a left thoracotomy and cannulated from the ventricular apex to the descending aorta. To modulate the pump speed synchronized with the heartbeat, custom-made real-time software detected the QRS complex of the electrocardiogram and controlled the pump speed during systole and diastole. Four different speed modulations with the same average speed but different systolic and diastolic speeds were compared with the baseline and the constant speed support. Left ventricular (LV) pressure and volume, coronary flow and pump flow were analysed to examine the influence of the pump speed modulation.RESULTS: Pulsatile setting reduces the cardiac workload to 64% of the baseline and 72% of the constant speed value. Maximum unloading is obtained with the highest speed during diastole and high-pulse amplitude. End-diastolic volume in the pulsatile modes varied from 85 to 94% of the baseline and 96 to 107% of the constant speed value. Consequently, the mechanical load on the heart can be adjusted to provide assuagement, which may lead to myocardial recovery. The higher pump speed during systole results in an increase in the pulse pressure up to 140% compared with the constant speed.CONCLUSIONS: The present study is an initial step to more accurate speed modulation of RBPs to optimize the cardiac load control. To develop future control algorithms, the concept of high speed during diastole having a maximal unloading effect on the LV and high speed during systole increasing the pulse pressure is worth considering.