Evaluation of centrifugal blood pump performances for biventricular support in the virtual simulation model.

Abstract

Despite the advances in the left ventricular assist device (LVAD), there are still situations that require a biventricular assist device (BVAD) system. The purpose of this study was to explore and compare the system performance interactions with the HeartMate3 (HM3) and HeartWare (HVAD) in a BVAD configuration using the virtual mock loop (VML) simulation tool. The VML simulation tool is an in silico implementation of a lumped parameter model of the cardiovascular system with mechanical circulatory support. Patients with ejection fractions of 60%, 20%, and 15% were simulated in VML, and the HVAD and HM3 in a BVAD with ventricular cannulation were applied to simulated conditions. Pump speeds that restored baseline normal hemodynamics were determined. To determine the optimal speeds for BVAD, the left and right arterial pressures (LAP, RAP) were plotted. In the HVAD, LAP and RAP are balanced at 11mm Hg with LVAD 3500rpm, right ventricular assist device (RVAD) 2200rpm; at 13mm Hg with LVAD 3000rpm, RVAD 1700rpm; and at 14mm Hg with LVAD 2500rpm, RVAD 1300rpm. For the HM3, at 8mm Hg with LVAD 7000rpm, RVAD 5000rpm; at 9mm Hg with LVAD 6000rpm, RVAD 4300rpm; and at 9.5mm Hg with LVAD 5000rpm, RVAD 3500rpm. The RVAD/LVAD speed ratios required for atrial balance were approximately 0.6 for the HVAD and 0.7 for the HM3. However, the HVAD required RVAD speeds below its range of operation.