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首页> 外文期刊>Artificial Organs >The Importance of Venous Return in Starling‐Like Control of Rotary Ventricular Assist Devices
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The Importance of Venous Return in Starling‐Like Control of Rotary Ventricular Assist Devices

机译：静脉返回在旋转室助性辅助装置的椋鸟控制中的重要性

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Abstract Rotary ventricular assist devices (VADs) are less sensitive to preload than the healthy heart, resulting in inadequate flow regulation in response to changes in patient cardiac demand. Starling‐like physiological controllers (SLCs) have been developed to automatically regulate VAD flow based on ventricular preload. An SLC consists of a cardiac response curve (CRC) which imposes a nonlinear relationship between VAD flow and ventricular preload, and a venous return line (VRL) which determines the return path of the controller. This study investigates the importance of a physiological VRL in SLC of dual rotary blood pumps for biventricular support. Two experiments were conducted on a physical mock circulation loop (MCL); the first compared an SLC with an angled physiological VRL (SLC‐P) against an SLC with a vertical VRL (SLC‐V). The second experiment quantified the benefit of a dynamic VRL, represented by a series of specific VRLs, which could adapt to different circulatory states including changes in pulmonary (PVR) and systemic (SVR) vascular resistance versus a fixed physiological VRL which was calculated at rest. In both sets of experiments, the transient controller responses were evaluated through reductions in preload caused by the removal of fluid from the MCL. The SLC‐P produced no overshoot or oscillations following step changes in preload, whereas SLC‐V produced 0.4 L/min (12.5%) overshoot for both left and right VADs. Additionally, the SLC‐V had increased settling time and reduced controller stability as evidenced by transient controller oscillations. The transient results comparing the specific and standard VRLs demonstrated that specific VRL rise times were improved by between 1.2 and 4.7 s ( x ˉ = 3.05 s), while specific VRL settling times were improved by between 2.8 and 16.1 seconds ( x ˉ = 8.38 s) over the standard VRL. This suggests only a minor improvement in controller response time from a dynamic VRL compared to the fixed VRL. These results indicate that the use of a fixed physiologically representative VRL is adequate over a wide variety of physiological conditions.
机译：摘要旋转室外辅助装置（VADS）对预加载的敏感性比健康的心脏不太敏感，导致流量调节不足，以应对患者心脏需求的变化。已经开发出椋鸟状的生理控制器（SLCS），以自动调节基于心室预载荷的VAD流。 SLC由心脏响应曲线（CRC）构成，其施加VAD流动和心室预紧载荷之间的非线性关系，以及确定控制器的返回路径的静脉返回管线（VRL）。本研究研究了用于五齿载体的双旋转血液泵SLC中生理VRL的重要性。在物理模拟循环回路（MCL）上进行两个实验;首先将具有垂直VRL（SLC-V）的SLC具有抗角生理VRL（SLC-P）的SLC。第二实验量化了由一系列特异性VRL表示的动态VRL的益处，其可以适应不同的循环状态，包括肺（PVR）和全身（SVR）血管阻力的变化与固定的生理VRL在静止时计算。在两组实验中，通过从MCL中除去流体引起的预加载减少来评估瞬态控制器响应。 SLC-P在预载的步骤变化后没有产生过冲或振荡，而SLC-V产生0.4L / min（12.5％）左侧和右侧VAD的过冲。另外，SLC-V具有增加的稳定时间和减少的控制器稳定性，如瞬态控制器振荡所证明的。比较特定和标准VRL的瞬态结果证明了1.2和4.7 s（x = 3.05秒之间的特定VRL上升时间（x = 3.05秒），而特定的VRL稳定时间在2.8和16.1秒之间得到改善（x = 8.38秒）通过标准VRL。这表明与固定VRL相比，从动态VRL的控制器响应时间仅进行了微小的改进。这些结果表明，使用固定的生理学代表性VRL在各种生理条件下足够。

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