Effect of continuous flow biventricular assist device on pressure-volume loop: A simulation study

Abstract

Biventricular assist device (BiVAD) support is a mechanical circulatory support using both left ventricular assist device (LVAD) and right ventricular assist device (RVAD). BiVAD support is now increasingly used as an alternative treatment for end-stage heart failure patients, such as bridge to transplantation, bridge to recovery, and permanent support. Both flow balancing and Starling response of the right and left ventricles should be concerned to prevent the suction event on both right and left ventricles. In this study, the cardiovascular system model using the rotary blood pump was implemented to study the mechanical circulatory support management during left ventricular assist device (LVAD) support alone and during BiVAD support. The pathological ventricles were generated by reducing the maximum elastance (Emax) in the model. The pressure-volume loop of difference heart conditions (normal ventricle: 100% of Emax, pathological ventricle: 50% of Emax) and the levels of pump support (non-support, partial support and full support) were simulated. From all simulations, the suction events in the right ventricle (represented by negative values of right ventricular volume and pressure) were observed during the unbalanced flow conditions of BiVAD support. Therefore, the flow balancing or pump speed adjustment is a key for BiVAD management.