Hemodynamic effects of synchronizing an intra-aortic VAD in reverse-rotation control with left ventricle: a mock loop study.

Abstract

The IntraVAD is an intra-aortic left ventricular assist device (LVAD) to be located in the ascending aorta. In order to enhance unloading and promote coronary flow for the left ventricle (LV), an operating mechanism, reverse-rotation control (RRc) mode, has been developed for the IntraVAD and tested in vitro in a mock circulation loop (MCL). The RRc mode consists of forward rotation (FR) and reverse rotation (RR). The synchronization between the IntraVAD and the LV was studied to offload the ventricle more effectively and to improve myocardial perfusion. The percentage time length of the FR period in the cardiac cycle (Tlf) and time offset between the central-lines of the FR period and the LV systole (Toc) are two parameters of the RRc mode that were varied to adjust the synchronization between the IntraVAD and the LV. The ejection fraction (EF), coronary perfusion pressure (CPP), and arterial pulsatility index (API) were measured at different Tlf and Toc values. These hemodynamic results closely correlated to the LV unloading, coronary perfusion, and peripheral arterial pulsatility. The EF, CPP and API were fed into a weighted normalized scalar (WNS) which was implemented to comprehensively evaluate the hemodynamic influence. The WNS result shows that the overall hemodynamic response is more sensitive to the changes in Toc value than Tlf value. The result shows a significant reduction in LV afterload by starting the FR before LV contraction, then switching to RR at the onset of ventricular dilation. The optimal phase shift of -π/5 was found to precede LV contraction, indicating that changes in LV afterload are more sensitive to the phase shift at the start of the ventricular systole than at the end. Thus, a phase advance between intra-aortic pumps and the LV is critical to unload the ventricle and promote myocardial recovery.