Modeling Partial and Total Support of Left Ventricular Assist Device for Discrete Hemodynamic Control Framework.

Area of Science:

• Cardiovascular Engineering
• Medical Device Control Systems
• Heart Failure Pathophysiology

Background:

• Acute heart failure (AHF) presents complex hemodynamic challenges.
• Existing therapies, including drug treatment and left ventricular assist devices (LVADs), have limitations in severe cases.
• Optimizing myocardial oxygen consumption ($MVO\_{2}$) is crucial for cardiac recovery.

Purpose of the Study:

• To develop a model-based control framework integrating LVAD support with drug therapy for AHF.
• To regulate multidimensional hemodynamics (mean arterial pressure, cardiac output, atrial pressures) while minimizing $MVO\_{2}$.
• To enable combined drug-LVAD therapy for severe AHF unresponsive to monotherapy.

Main Methods:

• Extended a pre-existing hemodynamic control framework to incorporate LVAD functionality.
• Developed an analytical $MVO\_{2}$ model accounting for partial and total LVAD support modes.
• Implemented an optimal controller managing transitions between LVAD support levels within a cardiovascular simulator.

Main Results:

• The $MVO\_{2}$ model demonstrated accurate predictions across different LVAD support scenarios.
• In a simulated severe AHF, the combined drugs-LVAD controller successfully achieved hemodynamic regulation and $MVO\_{2}$ minimization.
• Compared to drug therapy alone, the integrated approach halved $MVO\_{2}$ while maintaining multidimensional hemodynamic control.

Conclusions:

• The developed drugs-LVAD framework offers a promising strategy for hemodynamic management in severe AHF.
• Integrated control effectively reduces $MVO\_{2}$ and cardiac workload.
• Accurate modeling of both partial and total LVAD support is essential for optimal hemodynamic management.