Key result
Moving a single pressure sensor to the base of a 450-mm cannula decreased preload sensitivity to 0.22 (L/min)/mm Hg, indicating potential for simple VAD controllers without complex sensor arrays.
Simple pressure controllers with a single sensor can achieve increased preload sensitivity by tailoring cannula selection and sensor location, avoiding the need for complex multi-sensor arrays in biventricular support systems.
Single-sensor VAD control may simplify biventricular support; animal data are hypothesis-generating and require human validation.
The use of rotary left ventricular assist devices (LVADs) has extended to destination and recovery therapy for end-stage heart failure. Incidence of right ventricular failure while on LVAD support requires a second device be implanted to support the failing right ventricle. Without a commercially available implantable rotary right ventricular assist device, rotary LVADs are cannulated into the right heart and operation modified to provide suitable support for the pulmonary system. While this approach can alleviate the demand for transplant through long-term biventricular support, it uncovers a new challenge with respect to controller strategies for these dual device support systems. This study compares the preload sensitivity of rotary, dual device biventricular assistance controllers in light of their ability to adjust the flow rate according to physiological demand. A Frank-Starling-like flow controller which requires both inlet pressure and flow sensors is compared to pressure controllers which maintain atrial or inlet cannula pressures through the use of a single pressure sensor. It was found that cannula selection and the location of a pressure controller's single pressure sensor can be tailored to adjust the preload sensitivity. When located within the atria, this sensitivity is effectively infinite. Moving the sensor to the base of a 450-mm cannula, however, decreased the sensitivity to 0.22 (L/min)/mm Hg. This indicates the potential for simple and reliable VAD controllers with increased preload sensitivity without the need for complex controllers requiring an array of hemodynamic sensors.
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Gaddum et al. (2011) studied End-stage heart failure requiring biventricular support. Frank-Starling-like flow controller vs. Pressure controllers with a single pressure sensor was evaluated on Preload sensitivity. Moving a single pressure sensor to the base of a 450-mm cannula decreased preload sensitivity to 0.22 (L/min)/mm Hg, indicating potential for simple VAD controllers without complex sensor arrays.
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