Asymmetric speed modulation of a rotary blood pump affects ventricular unloading

OBJECTIVES: Rotary blood pumps (RBPs) running at a constant speed are routinely used for the mechanical support of the heart in various clinical applications, from short-term use in heart-lung machines to long-term support of a failing heart. Their operating range is delineated by suction and regurgitation events, leaving limited control on the cardiac workload. This study investigates whether different ratios of systolic/diastolic support are advantageous over a constant-speed operation. METHODS: In order to effectively control the load on the heart, this study aimed at developing a pulsatile control algorithm for rotary pumps to investigate the impact of pump speed modulation during systole and diastole on the left ventricle unloading. The CentriMag (TM) RBP with a modified controller was implanted in four sheep via a left thoracotomy and cannulated from the ventricular apex to the descending aorta. To modulate the pump speed synchronized with the heartbeat, custom-made real-time software detected the QRS complex of the electrocardiogram and controlled the pump speed during systole and diastole. Four different speed modulations with the same average speed but different systolic and diastolic speeds were compared with the baseline and the constant speed support. Left ventricular (LV) pressure and volume, coronary flow and pump flow were analysed to examine the influence of the pump speed modulation. RESULTS: Pulsatile setting reduces the cardiac workload to 64% of the baseline and 72% of the constant speed value. Maximum unloading is obtained with the highest speed during diastole and high-pulse amplitude. End-diastolic volume in the pulsatile modes varied from 85 to 94% of the baseline and 96 to 107% of the constant speed value. Consequently, the mechanical load on the heart can be adjusted to provide assuagement, which may lead to myocardial recovery. The higher pump speed during systole results in an increase in the pulse pressure up to 140% compared with the constant speed. CONCLUSIONS: The present study is an initial step to more accurate speed modulation of RBPs to optimize the cardiac load control. To develop future control algorithms, the concept of high speed during diastole having a maximal unloading effect on the LV and high speed during systole increasing the pulse pressure is worth considering.