A monitoring and physiological control system for determining aortic valve closing with a ventricular assist device

Abstract

Real-time monitoring of the aortic valve function and the loading state of the left ventricle (LV) during mechanical circulatory support is essential. Therefore, we developed a system that determines accurately the aortic valve closing moment based on integrals derived from the pump inlet pressure and the pump power [pressure-power area (PPA)]. A Deltastream diagonal pump was implanted in 10 healthy Rhoen sheep. Changes in ventricular volume and pressure in different assist levels were measured by a conductance catheter placed in the LV and were correlated with intrinsic pump signals, motor power, voltage and current. Measurements were obtained in the state of normal as well as decreased left ventricular contractility induced by β-blockers. Complete datasets were obtained in seven animals. The PPA-feedback signal reached its maximum at the speed of aortic valve closing. This was validated by pressure-volume (PV)-catheter measurements both at the baseline and in the state of decreased contractility. In both cases, zero-crossing occurred at the point of aortic valve closing speed. With this trial, we deliver the experimental basis for the development of an automatic feedback controller that would allow periodic speed changes in accordance with the loading state of the native ventricle and the opening state of the aortic valve. This would deliver real-time data to treating physicians and enable the establishment of a standard weaning protocol.