Comparison of preload-sensitive pressure and flow controller strategies for a dual device biventricular support...

The use of rotary left ventricular assist devices (LVADs) has extended to destination and recovery therapy for end-stage heart failure. Incidence of right ventricular failure while on LVAD support requires a second device be implanted to support the failing right ventricle. Without a commercially available implantable rotary right ventricular assist device, rotary LVADs are cannulated into the right heart and operation modified to provide suitable support for the pulmonary system. While this approach can alleviate the demand for transplant through long-term biventricular support, it uncovers a new challenge with respect to controller strategies for these dual device support systems. This study compares the preload sensitivity of rotary, dual device biventricular assistance controllers in light of their ability to adjust the flow rate according to physiological demand. A Frank-Starling-like flow controller which requires both inlet pressure and flow sensors is compared to pressure controllers which maintain atrial or inlet cannula pressures through the use of a single pressure sensor. It was found that cannula selection and the location of a pressure controller's single pressure sensor can be tailored to adjust the preload sensitivity. When located within the atria, this sensitivity is effectively infinite. Moving the sensor to the base of a 450-mm cannula, however, decreased the sensitivity to 0.22 (L/min)/mm Hg. This indicates the potential for simple and reliable VAD controllers with increased preload sensitivity without the need for complex controllers requiring an array of hemodynamic sensors.