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Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility

Despite the widespread acceptance of rotary blood pump (RBP) in clinical use over the past decades, the diminished flow pulsatility generated by a fixed speed RBP has been regarded as a potential factor that may lead to adverse events such as vasculature stiffening and hemorrhagic strokes. In this s...

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Main Authors: Ng, Boon Chiang, Kleinheyer, Matthias, Smith, Peter Alex, Timms, Daniel Lee, Cohn, William E., Lim, Einly
Format: Article
Published: Public Library of Science 2018
Subjects:
R Medicine
Online Access:http://eprints.um.edu.my/21151/
https://doi.org/10.1371/journal.pone.0195975
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spelling my.um.eprints.211512019-05-07T07:54:49Z http://eprints.um.edu.my/21151/ Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility Ng, Boon Chiang Kleinheyer, Matthias Smith, Peter Alex Timms, Daniel Lee Cohn, William E. Lim, Einly R Medicine Despite the widespread acceptance of rotary blood pump (RBP) in clinical use over the past decades, the diminished flow pulsatility generated by a fixed speed RBP has been regarded as a potential factor that may lead to adverse events such as vasculature stiffening and hemorrhagic strokes. In this study, we investigate the feasibility of generating physiological pulse pressure in the pulmonary circulation by modulating the speed of a right ventricular assist device (RVAD) in a mock circulation loop. A rectangular pulse profile with predetermined pulse width has been implemented as the pump speed pattern with two different phase shifts (0% and 50%) with respect to the ventricular contraction. In addition, the performance of the speed modulation strategy has been assessed under different cardiovascular states, including variation in ventricular contractility and pulmonary arterial compliance. Our results indicated that the proposed pulse profile with optimised parameters (Apulse = 10000 rpm and ωmin = 3000 rpm) was able to generate pulmonary arterial pulse pressure within the physiological range (9–15 mmHg) while avoiding undesirable pump backflow under both co- and counter-pulsation modes. As compared to co-pulsation, stroke work was reduced by over 44% under counter-pulsation, suggesting that mechanical workload of the right ventricle can be efficiently mitigated through counter-pulsing the pump speed. Furthermore, our results showed that improved ventricular contractility could potentially lead to higher risk of ventricular suction and pump backflow, while stiffening of the pulmonary artery resulted in increased pulse pressure. In conclusion, the proposed speed modulation strategy produces pulsatile hemodynamics, which is more physiologic than continuous blood flow. The findings also provide valuable insight into the interaction between RVAD speed modulation and the pulmonary circulation under various cardiovascular states. Public Library of Science 2018 Article PeerReviewed Ng, Boon Chiang and Kleinheyer, Matthias and Smith, Peter Alex and Timms, Daniel Lee and Cohn, William E. and Lim, Einly (2018) Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility. PLoS ONE, 13 (4). e0195975. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0195975 doi:10.1371/journal.pone.0195975
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Ng, Boon Chiang
Kleinheyer, Matthias
Smith, Peter Alex
Timms, Daniel Lee
Cohn, William E.
Lim, Einly
Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility
description Despite the widespread acceptance of rotary blood pump (RBP) in clinical use over the past decades, the diminished flow pulsatility generated by a fixed speed RBP has been regarded as a potential factor that may lead to adverse events such as vasculature stiffening and hemorrhagic strokes. In this study, we investigate the feasibility of generating physiological pulse pressure in the pulmonary circulation by modulating the speed of a right ventricular assist device (RVAD) in a mock circulation loop. A rectangular pulse profile with predetermined pulse width has been implemented as the pump speed pattern with two different phase shifts (0% and 50%) with respect to the ventricular contraction. In addition, the performance of the speed modulation strategy has been assessed under different cardiovascular states, including variation in ventricular contractility and pulmonary arterial compliance. Our results indicated that the proposed pulse profile with optimised parameters (Apulse = 10000 rpm and ωmin = 3000 rpm) was able to generate pulmonary arterial pulse pressure within the physiological range (9–15 mmHg) while avoiding undesirable pump backflow under both co- and counter-pulsation modes. As compared to co-pulsation, stroke work was reduced by over 44% under counter-pulsation, suggesting that mechanical workload of the right ventricle can be efficiently mitigated through counter-pulsing the pump speed. Furthermore, our results showed that improved ventricular contractility could potentially lead to higher risk of ventricular suction and pump backflow, while stiffening of the pulmonary artery resulted in increased pulse pressure. In conclusion, the proposed speed modulation strategy produces pulsatile hemodynamics, which is more physiologic than continuous blood flow. The findings also provide valuable insight into the interaction between RVAD speed modulation and the pulmonary circulation under various cardiovascular states.
format Article
author Ng, Boon Chiang
Kleinheyer, Matthias
Smith, Peter Alex
Timms, Daniel Lee
Cohn, William E.
Lim, Einly
author_facet Ng, Boon Chiang
Kleinheyer, Matthias
Smith, Peter Alex
Timms, Daniel Lee
Cohn, William E.
Lim, Einly
author_sort Ng, Boon Chiang
title Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility
title_short Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility
title_full Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility
title_fullStr Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility
title_full_unstemmed Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility
title_sort pulsatile operation of a continuous-flow right ventricular assist device (rvad) to improve vascular pulsatility
publisher Public Library of Science
publishDate 2018
url http://eprints.um.edu.my/21151/
https://doi.org/10.1371/journal.pone.0195975
_version_ 1643691480706973696
score 13.211869

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