Biomedical subjects

Guruprasad A Giridharan

Publications and source records attributed to Guruprasad A Giridharan.

9 recordsLinked to original sources

PubMed2006

Physiological control of blood pumps using intrinsic pump parameters: a computer simulation study.

Implantable flow and pressure sensors, used to control rotary blood pumps, are unreliable in the long term. It is, therefore, desirable to develop a physiological control system that depends only on readily available measurements of the intrinsic pump parameters, such as measurements of the pump current, voltage, and speed (in revolutions per minute). A previously proposed DeltaP control method of ventricular assist devices (VADs) requires the implantation of two pressure sensors to measure the pressure difference between the left ventricle and aorta. In this article, we propose a model-based method for estimating DeltaP, which eliminates the need for implantable pressure sensors. The developed estimator consists of the extended Kalman filter in conjunction with the Golay-Savitzky filter. The performance of the combined estimator-VAD controller system was evaluated in computer simulations for a broad range of physical activities and varying cardiac conditions. The results show that there was no appreciable performance degradation of the estimator-controller system compared to the case when DeltaP is measured directly. The proposed approach effectively utilizes a VAD as both a pump and a differential pressure sensor, thus eliminating the need for dedicated implantable pressure and flow sensors. The simulation results show that different pump designs may not be equally effective at playing a dual role of a flow actuator and DeltaP sensor.

Computer Simulation↗

PubMed2005

Ascending aorta outflow graft location and pulsatile ventricular assist provide optimal hemodynamic support in an adult mock circulation.

Although continuous flow (CF) and pulsatile flow (PF) ventricular assist devices (VADs) are being clinically used, their effects on aortic blood flow, as a measure of overall blood distribution, remain unclear. In acute VAD support animal experiments, our group has described a zone of turbulent mixing in the aortic arch. The objective of this study was to confirm this finding in the controlled setting of an adult mock circulation, simulating ventricular pathophysiologic states (normal and failing ventricle). CF and PF flow VADs were connected to ventricular apical inflow and ascending aorta (AA) or descending aorta (DA) outflow cannulae. Cardiovascular pressure and flow waveforms were recorded at varying levels of VAD bypass resulting in four test conditions: (i) CF-AA; (ii) CF-DA; (iii) PF-AA; and (iv) PF-DA. Confirming the animal data, no differences in mean aortic flow between CF and PF VADs were found, and significantly lower mean aortic arch flow with DA cannulation was noted. Mean aortic root flow decreased with increasing VAD bypass flow. As in the animal studies, despite similar mean flow rates, significant differences in waveform morphology were observed for AA and DA outflow graft locations and varying levels of VAD bypass. At 100% VAD support in the failing heart, PF restored waveform pulsatility to normal baseline while CF resulted in little pulsatility. These results confirm our earlier findings in the animal model, suggesting that outflow graft location may have a significant effect on aortic blood flow distribution. The long-term implications of these findings are being examined in ongoing studies.

Adult↗

PubMed2003

Control strategy for maintaining physiological perfusion with rotary blood pumps.

We present arguments and simulation results in favor of a novel strategy for control of rotary blood pumps. We suggest that physiological perfusion is achieved when the blood pump is controlled to maintain an average reference differential pressure. In the case of rotary left ventricular assist devices, our simulations show that maintaining a constant average pressure difference between the left ventricle and aorta results in physiological perfusion over a wide range of physical activities and clinical cardiac conditions. We simulated rest, light, and strenuous exercise conditions, corresponding to cardiac demands of 4.92, 7.98, and 14.62 L/min, respectively. For different exercise levels, the clinical conditions ranged from normal to failing to asystolic heart. By maintaining a constant pressure difference of 75 mm Hg between the left ventricle and aorta, with either an axial or a centrifugal blood pump, a total cardiac output close to the physiological cardiac demand was achieved, irrespective of the heart condition. The simulations of the transitions between different levels of exercise indicate that with the same reference differential pressure, the proposed approach leads to rapid adaptation of the total cardiac output to physiological levels, while avoiding suction. Comparison with the traditional control strategy of maintaining a reference rotational speed (rpm) of the pump indicates that though the traditional approach has some degree of adaptability, it is only adequate over a narrow range of cardiac demand and clinical conditions of the patient. Our results indicate that the proposed approach is superior to the alternatives in providing an adequate and autonomous adaptation of the total cardiac output over a broad range of exercise conditions (expected when an assist device is used as a destination therapy) and clinical statuses of the native heart (such as further deterioration or recovery of cardiac function), while having the potential to improve the quality of life of patients by reducing the need for monitoring and frequent human intervention. The proposed approach can be clinically implemented using simple controllers, and requires the implantation of two pressure sensors, or estimation of the pressure difference based on other available measurements.

Biomechanical Phenomena↗

PubMed2002

Nonlinear controller for ventricular assist devices.

This paper presents the design of a gain-scheduled proportional integral (PI) feedback controller for ventricular assist devices to maintain physiologically motivated perfusion. The selected control objective is to maintain an average differential pressure deltaP between the left ventricle and the aorta. Computer simulations for different pathological conditions, ranging from the normal heart to left heart asystole, and a wide range of physiological scenarios, ranging from rest to strenuous exercise, were used to validate the performance of the controller and the effectiveness of the selected control objective in ensuring physiologically adequate perfusion under different clinical and cardiac demand conditions.

Aorta↗

PubMedDate not supplied

Modeling and control of a brushless DC axial flow ventricular assist device.

This article presents an integrated model of the human circulatory system that incorporates circulatory support by a brushless DC axial flow ventricular assist device (VAD), and a feedback VAD controller designed to maintain physiologically sufficient perfusion. The developed integrated model combines a network type model of the circulatory system with a nonlinear dynamic model of the brushless DC pump We show that maintaining a reference differential pressure between the left ventricle and aorta leads to adequate perfusion for different pathologic cases, ranging from normal heart to left heart asystole, and widely varying physical activity scenarios from rest to exercise.

Equipment Design↗

PubMedDate not supplied

Characterization of an adult mock circulation for testing cardiac support devices.

A need exists for a mock circulation that behaves in a physiologic manner for testing cardiac devices in normal and pathologic states. To address this need, an integrated mock cardiovascular system consisting of an atrium, ventricle, and systemic and coronary vasculature was developed specifically for testing ventricular assist devices (VADs). This test configuration enables atrial or ventricular apex inflow and aortic outflow cannulation connections. The objective of this study was to assess the ability of the mock ventricle to mimic the Frank-Starling response of normal, heart failure, and cardiac recovery conditions. The pressure-volume relationship of the mock ventricle was evaluated by varying ventricular volume over a wide range via atrial (preload) and aortic (afterload) occlusions. The input impedance of the mock vasculature was calculated using aortic pressure and flow measurements and also was used to estimate resistance, compliance, and inertial mechanical properties of the circulatory system. Results demonstrated that the mock ventricle pressure-volume loops and the end diastolic and end systolic pressure-volume relationships are representative of the Starling characteristics of the natural heart for each of the test conditions. The mock vasculature can be configured to mimic the input impedance and mechanical properties of native vasculature in the normal state. Although mock circulation testing systems cannot replace in vivo models, this configuration should be well suited for developing experimental protocols, testing device feedback control algorithms, investigating flow profiles, and training surgical staff on the operational procedures of cardiovascular devices.

Adult↗

PubMedDate not supplied

Left ventricular and myocardial perfusion responses to volume unloading and afterload reduction in a computer simulation.

Ventricular assist devices (VADs) have been used successfully as a bridge to transplant in heart failure patients by unloading ventricular volume and restoring the circulation. In a few cases, patients have been successfully weaned from these devices after myocardial recovery. To promote myocardial recovery and alleviate the demand for donor organs, we are developing an artificial vasculature device (AVD) that is designed to allow the heart to fill to its normal volume but eject against a lower afterload. Using this approach, the heart ejects its stroke volume (SV) into an AVD anastomosed to the aortic arch, which has been programmed to produce any desired afterload condition defined by an input impedance profile. During diastole, the AVD returns this SV to the aorta, providing counterpulsation. Dynamic computer models of each of the assist devices (AVD, continuous, and pulsatile flow pumps) were developed and coupled to a model of the cardiovascular system. Computer simulations of these assist techniques were conducted to predict physiologic responses. Hemodynamic parameters, ventricular pressure-volume loops, and vascular impedance characteristics were calculated with AVD, continuous VAD, and asynchronous pulsatile VAD support for a range of clinical cardiac conditions (normal, failing, and recovering left ventricle). These simulation results indicate that the AVD may provide better coronary perfusion, as well as lower vascular resistance and elastance seen by the native heart during ejection compared with continuous and pulsatile VAD. Our working hypothesis is that by controlling afterload using the AVD approach, ventricular cannulation can be eliminated, myocardial perfusion improved, myocardial compliance and resistance restored, and effective weaning protocols developed that promote myocardial recovery.

Compliance↗

PubMedDate not supplied

Physiologic control of rotary blood pumps: an in vitro study.

Rotary blood pumps (RBPs) are currently being used as a bridge to transplantation as well as for myocardial recovery and destination therapy for patients with heart failure. Physiologic control systems for RBPs that can automatically and autonomously adjust the pump flow to match the physiologic requirement of the patient are needed to reduce human intervention and error, while improving the quality of life. Physiologic control systems for RBPs should ensure adequate perfusion while avoiding inflow occlusion via left ventricular (LV) suction for varying clinical and physical activity conditions. For RBPs used as left ventricular assist devices (LVADs), we hypothesize that maintaining a constant average pressure difference between the pulmonary vein and the aorta (deltaPa) would give rise to a physiologically adequate perfusion while avoiding LV suction. Using a mock circulatory system, we tested the performance of the control strategy of maintaining a constant average deltaPa and compared it with the results obtained when a constant average pump pressure head (deltaP) and constant rpm are maintained. The comparison was made for normal, failing, and asystolic left heart during rest and at light exercise. The deltaPa was maintained at 95 +/- 1 mm Hg for all the scenarios. The results indicate that the deltaPa control strategy maintained or restored the total flow rate to that of the physiologically normal heart during rest (3.8 L/m) and light exercise (5.4 L/m) conditions. The deltaPa approach adapted to changing exercise and clinical conditions better than the constant rpm and constant deltaP control strategies. The deltaPa control strategy requires the implantation of two pressure sensors, which may not be clinically feasible. Sensorless RBP control using the deltaPa algorithm, which can eliminate the failure prone pressure sensors, is being currently investigated.

Blood Circulation↗

PubMedDate not supplied

Predicted hemodynamic benefits of counterpulsation therapy using a superficial surgical approach.

A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0-50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure-volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients.

Computer Simulation↗