Why the study?
Does left ventricular load impedance control by an apical VAD improve hemodynamic parameters in a simulated pathological left ventricle?
Does left ventricular load impedance control by an apical VAD improve hemodynamic parameters in a simulated pathological left ventricle?
Numerical simulations suggest that controlling left ventricular load impedance via an apical VAD can improve hemodynamics and promote pathological heart recovery.
Hemodynamic gains in this animal model warrant no clinical VAD changes; leaves open translation of impedance control to human LV failure.
The aim of this work is to investigate the dependence between left ventricular load impedance control by an apical ventricular assist device (VAD) and the consequent benefits for pathological heart recovery. A pathological left ventricle with 34% contractility has been simulated in the assisted and nonassisted conditions. By means of an extended Kalman filter, left ventricular pressure-volume loops have been partially estimated and ventricular as well as circulatory quantities inferred. The heart operation mode, based on cardiac energetic criteria, is imposed by controlling the VAD filling phase. In the assisted condition, results show that the left ventricle end-diastolic volume, left atrial pressure, and wall stress all decrease; stroke volume, ejection fraction, ventricular efficiency, aortic pressure, and cardiac output all increase. Benefits are also evident for the right ventricle and systemic and pulmonary circulation. The strategy outlined in this work also shows that good results for heart recovery are achievable and a possible way to improve the functional properties of commercial pulsatile VADs.
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Colacino et al. (2007) studied this question.
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