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Theoretical Foundations of a Starling-Like Controller for Rotary Blood Pumps

机译：旋转式血泵类似Starling控制器的理论基础

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摘要

A clinically intuitive physiologic controller is desired to improve the interaction between implantable rotary blood pumps and the cardiovascular system. This controller should restore the Starling mechanism of the heart, thus preventing overpumping and underpumping scenarios plaguing their implementation. A linear Starling-like controller for pump flow which emulated the response of the natural left ventricle (LV) to changes in preload was then derived using pump flow pulsatility as the feedback variable. The controller could also adapt the control line gradient to accommodate longer-term changes in cardiovascular parameters, most importantly LV contractility which caused flow pulsatility to move outside predefined limits. To justify the choice of flow pulsatility, four different pulsatility measures (pump flow, speed, current, and pump head pressure) were investigated as possible surrogates for LV stroke work. Simulations using a validated numerical model were used to examine the relationships between LV stroke work and these measures. All were approximately linear (r 2 (mean±SD)=0.989±0.013, n=30) between the limits of ventricular suction and opening of the aortic valve. After aortic valve opening, the four measures differed greatly in sensitivity to further increases in LV stroke work. Pump flow pulsatility showed more correspondence with changes in LV stroke work before and after opening of the aortic valve and was least affected by changes in the LV and right ventricular (RV) contractility, blood volume, peripheral vascular resistance, and heart rate. The system (flow pulsatility) response to primary changes in pump flow was then demonstrated to be appropriate for stable control of the circulation. As medical practitioners have an instinctive understanding of the Starling curve, which is central to the synchronization of LV and RV outputs, the intuitiveness of the proposed Starling-like controller will promote acceptance and enable rational integration into patterns of hemodynamic management.
机译：需要临床上直观的生理控制器来改善可植入式旋转血泵与心血管系统之间的相互作用。该控制器应恢复心脏的Starling机制，从而防止使它们的实现陷入困境的过度泵送和泵送不足情况。然后，使用泵流量的脉动性作为反馈变量，推导了类似泵的线性Starling控制器，该控制器模拟了自然左心室（LV）对预紧力变化的响应。控制器还可以调整控制线的斜度，以适应心血管参数的长期变化，最重要的是左室收缩，导致血流脉动超出预定范围。为了证明选择流体脉动性的合理性，研究了四种不同的脉动性测量方法（泵的流量，速度，电流和泵头压力），作为LV冲程工作的可能替代方法。使用经过验证的数值模型进行的模拟被用来检验左室卒中功与这些措施之间的关系。所有这些在心室吸力极限和主动脉瓣打开范围之间近似线性（r 2（平均值±SD）= 0.989±0.013，n = 30）。主动脉瓣打开后，这四种措施对进一步增加左室卒中工作的敏感性差异很大。泵流搏动性显示与主动脉瓣打开前后左室卒中工作的变化更相关，并且受左室和右心室（RV）收缩力，血容量，外周血管阻力和心率变化的影响最小。然后证明了对泵流量的主要变化的系统（流量脉动性）响应适用于稳定的循环控制。由于医生对Starling曲线具有本能的理解，而Starling曲线对于LV和RV输出的同步至关重要，因此拟议的Starling样控制器的直观性将促进接受度，并使之合理地整合到血液动力学管理模式中。

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