Objective: Continuous Flow Left Ventricular Assist Devices (CFLVAD) are circulatory support devices that are implanted in patients with end-stage heart failure. We developed a novel control algorithm for CFLVAD to maintain physiologic perfusion while avoiding ventricular suction using only the intrinsic pump measurement of pump speed and without utilizing model-based estimation.
Methods: The controller objective is to maintain a differential pump speed setpoint. A mathematical model of the circulatory system coupled with a model of a CFLVAD was used to test the control algorithm in silico. Robustness and efficacy were evaluated by comparing the proposed control algorithm to constant speed control, differential pump pressure control, mean aortic pressure control, and ventricular end diastolic pressure control during (1) rest and exercise conditions, (2) a rapid eight-fold increase in pulmonary vascular resistance under rest and exercise, (3) transitions from rest to exercise, and exercise to rest, (4) safe mode during left ventricular asystole, and (5) RPM measurement noise of 1% to 10% for (1) to (4).
Results and conclusion: The control algorithm provided adequate perfusion while preventing ventricular suction for all test conditions. Performance did not deteriorate significantly with pump speed measurement noise of up to 6%. The safe mode successfully detected asystole and maintained adequate perfusion to sustain life even when the differential pump speed was low.
Significance: Maintaining a constant differential pump speed can simultaneously achieve physiologic perfusion and suction prevention without needing unreliable, direct measurements of flow or pressure, or complex parameter or model-based estimation techniques.