Improving arterial pulsatility by feedback control of a continuous flow left ventricular assist device via in silico modeling

Purpose: Continuous flow left ventricular assist devices (CF-LVADs) generally operate at a constant speed, which causes a decrease in pulse pressure and pulsatility in the arteries and allegedly may lead to late complications such as aortic insufficiency and gastrointestinal bleeding. The purpose of this study is to increase the arterial pulse pressure and pulsatility while obtaining more physiological hemodynamic signals, by controlling the CF-LVAD flow rate. Methods : A lumped parameter model was used to simulate the cardiovascular system including the heart chambers, heart valves, systemic and pulmonary arteries and veins. A baroreflex model was used to regulate the heart rate and a model of the Micromed DeBakey CF-LVAD (Micromed Technology, Houston, TX, USA) to simulate the pump dynamics at different operating speeds. A model simulating the flow rate through the aortic valve served as reference model. CF-LVAD operating speed was regulated by applying proportional-integral (PI) control to the pump flow rate. For comparison, the CF-LVAD was also operated at a constant speed, equaling the mean CF-LVAD speed as applied in pulsatile mode. Results : In different operating modes, at the same mean operating speeds, mean pump output, mean arterial pressure, end-systolic and end-diastolic volume and heart rate were the same over the cardiac cycle. However, the arterial pulse pressure and index of pulsatility increased by 50% in the pulsatile CF-LVAD support mode with respect to constant speed pump support. Conclusions: This study shows the possibility of obtaining more physiological pulsatile hemodynamics in the arteries by applying output-driven varying speed control to a CF-LVAD