Modeling Partial and Total Support of Left Ventricular Assist Device for Discrete Hemodynamic Control Framework

OBJECTIVES: This study develops a model-based control framework integrating a left ventricular assist device (LVAD) with drug therapy to regulate multidimensional hemodynamics (mean arterial pressure, cardiac output, and left and right atrial pressures) while minimizing myocardial oxygen consumption (MVO₂) in acute heart afailure (AHF). By modeling the hemodynamic and MVO₂ effects of partial and total LVAD support, the framework enables combined drugs-LVAD therapy for severe AHF cases where drug therapy alone is not effective. METHODS: A previously developed hemodynamic control framework was extended to incorporate LVAD support. Using circulatory equilibrium models under LVAD support, an analytical MVO₂ model encompassing both LVAD modes was derived from the relationship between MVO₂ and the ventricular pressure-volume area. An optimal controller explicitly accounts for transitions between partial and total LVAD support. In our cardiovascular simulator, we validated the MVO₂ model and evaluated the framework's multidimensional hemodynamic regulation and MVO₂ minimization capabilities. RESULTS: The MVO₂ model accurately predicted MVO₂ across the two LVAD modes. In a severe AHF scenario, drug therapy or LVAD support alone failed, whereas the combined drugs-LVAD controller succeeded in achieving both hemodynamic regulation and MVO₂ minimization. Compared with drug therapy alone, drugs-LVAD control using the proposed MVO₂ model halved MVO₂ while achieving multidimensional regulation. CONCLUSIONS: Our drugs-LVAD framework may enable multidimensional hemodynamic regulation while reducing MVO₂ in severe AHF. Modeling both partial and total LVAD support may be essential for hemodynamic management. SIGNIFICANCE: This work provides a theoretical basis for integrated drugs-LVAD control to achieve target hemodynamics while reducing cardiac workload.