Date on Master's Thesis/Doctoral Dissertation
Giridharan, Guruprasad Anapathur
Ventricular assist device; Pulsatile flow; Vasculature pulsatility; Cardiovascular modeling; Continuous flow
Heart valve prosthesis; Heart--Left ventricle
Purpose: Continuous flow (CF) left ventricular assist devices (LVAD) support diminishes vascular pressure pulsatility. Despite its recent clinical success and reliability, CF LVAD support has been associated with adverse events including gastrointestinal bleeding, aortic valve insufficiency, and hemorrhagic strokes. To overcome these limitations, we have developed flow/RPM modulation algorithms to provide vascular pulsatility using a CF LVAD. Methods: The effects of timing and synchronizing the CF LVAD flow/RPM modulation to the native ventricle, modulation amplitude, and modulation widths were studied on the native ventricle and vasculature using computer simulation, mock loop, and animal model studies. A total of over 100 combinations of flow modulation algorithms to modulate CF LVAD flow/RPM were tested for partial and full LVAD support modes. Results: Modulation of CF LVAD flow/RPM resulted in an increased arterial pressure pulsatility of up to 50 mmHg during asynchronous modulation and 20 mmHg during synchronous modulation. Synchronous CF LVAD RPM modulation allowed for a range of reduced left ventricular external work (LVEW) as compared to un-modulated CF LVAD support conditions. Full support co-pulsation (high RPM during systole, low RPM during diastole) created greater pulse pressures as compared to counter pulsation (high RPM during diastole, low RPM during systole). However, all full support modulation timings yielded higher pulse pressure than normal full support CF LVAD flow at low ventricular contractilities. Importantly, reduction in LVEW and increase in pulsatility may be adjusted to user-defined values while maintaining the same average CF LVAD flow rate. Conclusions: These LVAD flow/RPM modulations may reduce the incidence of adverse events associated with the CF LVAD therapy by increasing vascular pulsatility and reducing vascular impedance. Further, these methods of CF LVAD flow/RPM modulation may enable tailored unloading of the native ventricle to provide rest and rehabilitation (maximal unloading to rest followed by gradual reloading to wean), which may promote sustainable myocardial recovery.
Ising, Mickey S., "RPM and flow modulation for a continuous flow left ventricular assist device to increase vascular pulsatility : a computer simulation, mock circulation, and in-vivo animal study." (2011). Electronic Theses and Dissertations. Paper 660.