Control of ventricular unloading using an electrocardiogram-synchronized Thoratec paracorporeal ventricular assist device.

OBJECTIVE: Current pulsatile ventricular assist devices operate asynchronous with the left ventricle in fixed-rate or fill-to-empty modes because electrocardiogram-triggered modes have been abandoned. We hypothesize that varying the ejection delay in the synchronized mode yields more precise control of hemodynamics and left ventricular loading. This allows for a refined management that may be clinically beneficial. METHODS: Eight sheep received a Thoratec paracorporeal ventricular assist device (Thoratec Corp, Pleasanton, Calif) via ventriculo-aortic cannulation. Left ventricular pressure and volume, aortic pressure, pulmonary flow, pump chamber pressure, and pump inflow and outflow were recorded. The pump was driven by a clinical pneumatic drive unit (Medos Medizintechnik AG, Stolberg, Germany) synchronously with the native R-wave. The start of pump ejection was delayed between 0% and 100% of the cardiac period in 10% increments. For each of these delays, hemodynamic variables were compared with baseline data using paired t tests. RESULTS: The location of the minimum of stroke work was observed at a delay of 10% (soon after aortic valve opening), resulting in a median of 43% reduction in stroke work compared with baseline. Maximum stroke work occurred at a median delay of 70% with a median stroke work increase of 11% above baseline. Left ventricular volume unloading expressed by end-diastolic volume was most pronounced for copulsation (delay 0%). CONCLUSIONS: The timing of pump ejection in synchronized mode yields control over left ventricular energetics and can be a method to achieve gradual reloading of a recoverable left ventricle. The traditionally suggested counterpulsation is not optimal in ventriculo-aortic cannulation when maximum unloading is desired.

A novel interface for hybrid mock circulations to evaluate ventricular assist devices.

This paper presents a novel mock circulation for the evaluation of ventricular assist devices (VADs), which is based on a hardware-in-the-loop concept. A numerical model of the human blood circulation runs in real time and computes instantaneous pressure, volume, and flow rate values. The VAD to be tested is connected to a numerical-hydraulic interface, which allows the interaction between the VAD and the numerical model of the circulation. The numerical-hydraulic interface consists of two pressure-controlled reservoirs, which apply the computed pressure values from the model to the VAD, and a flow probe to feed the resulting VAD flow rate back to the model. Experimental results are provided to show the proper interaction between a numerical model of the circulation and a mixed-flow blood pump.

Craniospinal pressure-volume dynamics in phantom models.

Regulation of intracranial pressure (ICP) is vital to proper brain function. Pathologic conditions such as traumatic brain injury and hydrocephalus can cause lethal changes in ICP through an imbalance of fluid passage into and out of the craniospinal space. The relationship between craniospinal volume and pressure determines to a large extent whether such imbalance can be compensated or if it will lead to neuronal damage. Phantom models are predisposed for the evaluation of medical procedures and devices that alter volume in the spinal or cranial space. However, current phantoms have substantial limitations in the reproduction of craniospinal pressure-volume relationships, which need to be overcome prior to their deployment outside the basic research setting. We present herein a novel feedback controlled phantom for the reproduction of any physiologic or pathologic pressure-volume relation. We compare its performance to those of existing passive methods, showing that it follows reference curves more precisely during both infusion of large volumes and fast oscillatory volume changes.

Age-specific characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid dynamics.

The objective of this work is to quantify age-related differences in the characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid (CSF) dynamics. To this end, 3T phase-contrast magnetic resonance imaging blood and CSF flow data of eleven young (24 ± 3 years) and eleven elderly subjects (70 ± 5 years) with a comparable sex-ratio were acquired. Flow waveforms and their frequency composition, transfer functions from blood to CSF flows and cross-correlations were analyzed. The magnitudes of the frequency components of CSF flow in the aqueduct differ significantly between the two age groups, as do the frequency components of the cervical spinal CSF and the arterial flows. The males' aqueductal CSF stroke volumes and average flow rates are significantly higher than those of the females. Transfer functions and cross-correlations between arterial blood and CSF flow reveal significant age-dependence of phase-shift between these, as do the waveforms of arterial blood, as well as cervical-spinal and aqueductal CSF flows. These findings accentuate the need for age- and sex-matched control groups for the evaluation of cerebral pathologies such as hydrocephalus.

Investigation of ventricular cerebrospinal fluid flow phase differences between the foramina of Monro and the aqueduct of Sylvius.

In this paper, phase contrast magnetic resonance flow measurements of the foramina of Monro and the aqueduct of Sylvius of seven healthy volunteers are presented. Peak volume flow rates are of the order of 150 mm3/s for the aqueduct of Sylvius and for the foramina of Monro. The temporal shift between these volume flows is analyzed with a high-resolution cross-correlation scheme which reveals high subject-specific phase differences. Repeated measurements show the invariability of the phase differences over time for each volunteer. The phase differences as a fraction of one period range from -0.0537 to 0.0820. A mathematical model of the pressure dynamics is presented. The model features one lumped compartment per ventricle. The driving force of the cerebrospinal fluid is modeled through pulsating choroid plexus. The model includes variations of the distribution of the choroid plexus between the ventricles. The proposed model is able to reproduce the measured phase differences with a very small (5%) variation of the distribution of the choroid plexus between the ventricles and, therefore, supports the theory that the choroid plexus drives the cerebrospinal fluid motion.