Methods Inf Med 2006; 45(05): 574-583
DOI: 10.1055/s-0038-1634120
Original Article
Schattauer GmbH

The Impact of Rotary Blood Pump in Conjunction with Mechanical Ventilation on Ventricular Energetic Parameters

Numerical Simulation
C. De Lazzari
1   C.N.R., Institute of Clinical Physiology – Section of Rome, Italy
,
M. Darowski
2   P.A.N. Institute of Biocybernetics and Biomedical Engineering, Center of Excellence ARTOG, Warsaw, Poland
,
G. Ferrari
1   C.N.R., Institute of Clinical Physiology – Section of Rome, Italy
,
D. M. Pisanelli
3   C.N.R., Institute for Cognitive Science and Technology, Rome, Italy
,
G. Tosti
1   C.N.R., Institute of Clinical Physiology – Section of Rome, Italy
› Author Affiliations
Further Information

Publication History

Received: 15 June 2005

accepted: 02 February 2006

Publication Date:
07 February 2018 (online)

Summary

Objectives: Aim of this work is to study the impact of left ventricular rotary blood pump assistance, on energetic variables, when mechanical ventilation (MV) of the lungs is applied.

Methods: Computer simulation was used to perform this study. Lumped parameter models reproduce the circulatory system. Variable elastance models reproduce the Starling’s law of the heart for each ventricle. After the reproduction of ischemic heart disease left ventricular assistance was applied using a model of rotary blood pump. The pump speed was changed in steps and was assumed to be constant during each step. The influence of mechanical ventilation was introduced by different values of positive mean thoracic pressure.

Results: The increase of the rotational speed has a significant influence on some ventricular energetic variables. In fact it decreased left ventricular external work, left and right ventricular pressure-volume area and the left ventricular efficiency. Finally, it increased the right ventricular efficiency but had no influence on the right ventricular external work. The increase of thoracic pressure from –2 to +5 mmHg caused a significant decrease of external work, pressure-volume area (right ventricular pressure-volume area dropped up to 50%) and an increase of right ventricular efficiency (by 40%) while left ventricular efficiency remained almost stable.

Conclusions: Numerical simulation is a very suitable tool to predict changes of not easily measurable parameters such as energetic ventricular variables when mechanical assistance of heart and/or lungs is applied independently or simultaneously.

 
  • References

  • 1 Pae WE, Miller CA, Matthews Y, Pierce WS. Ventricular assist devices for postcardiotomy cardiogenic shock. A combined registry experience. Journal of Thoracic and Cardiovascular Surgery 1992; 104: 541-53.
  • 2 Hoy FBY, Mueller DK, Geiss DM, Munns JR, Bond LM, Linett CE, Gomez RC. Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps?. Annals of Thoracic Surgery 2000; 70 (04) 1259-63.
  • 3 Meyns BP, Sergeant PT, Daenen WJ, Flameng WJ. Left ventricular assistance with the transthoracic 24F Hemopump for recovery of the failing heart. Annals of Thoracic Surgery 1995; 60: 392-7.
  • 4 Merhige ME, Smalling RW, Cassidy D, Barrett R, Wise G, Short J, Wampler RK. Effect of the hemopump left ventricular assist device on regional myocardial perfusion and function. Reduction of ischemia during coronary occlusion. Circulation 1989; 80 (02) III 158-66.
  • 5 Wouters PF, Sukehiro S, Mollhoff T, Hendrikx M, Waldenberger FR, Wiebalck A, Flameng W. Left ventricular assistance using a catheter-mounted coaxial flow pump (Hemopump) in a canine model of regional myocardial ischemia. European Heart Journal 1993; 14 (04) 567-75.
  • 6 Marks JD, Pantalos GM, Long JW, Kinoshita M, Everett SD, Olsen DB. Myocardial mechanics, energetics, and hemodynamics during intraaortic balloon and transvalvular axial flow hemopump support with a bovine model of ischemic cardiac dysfunction. ASAIO J 1999; 45 (06) 602.
  • 7 Meyns B, Nishimura Y, Racz R, Jashari R, Flameng W. Organ perfusion with hemopump device assistance with and without intraaortic balloon pump. The Journal of Thoracic and Cardiovascular Surgery 1997; 114 (02) 243.
  • 8 De Lazzari C, Darowski M, Ferrari G, Clemente F, Guaragno M. Ventricular energetics during mechanical ventilation and intraaortic balloon pumping - computer simulation. Journal of Medical Engineering & Technology 2001; 25 (03) 103.
  • 9 De Lazzari C, Darowski M, Wolski P, Ferrari G, Tosti G, Pisanelli DM. In Vivo and Simulation Study of Artificial Ventilation Effects on Energetic Variables in Cardiosurgical Patients. Methods Inf Med 2005; 44 (01) 98-105.
  • 10 Pinski MR. The hemodynamic consequences of mechanical ventilation: an evolving story. Intens Care Med 1997; 23: 493-500.
  • 11 Miro AM, Pinsky MR. Heart lung interactions. In Tobin MJ. (ed.) Principles and practice of mechanical ventilation.. New York: Mc Graw-Hill Inc.; 1994. p 647
  • 12 Fewell JE, Abendschein DR, Carlson CJ, Murray JF, Rapaport E. Continuous positive-pressure ventilation decreases right and left ventricular end-diastolic volumes in the dog. Circulation Research 1980; 46: 125.
  • 13 Gali B, Goyal DG. Positive pressure mechanical ventilation. Emerg Med Clin North Am 2003; 21 (02) 435.
  • 14 Ferrari G, De Lazzari C, Mimmo R, Tosti G, Ambrosi D. A modular numerical model of the cardiovascular system for studying and training in the field of cardiovascular physiopathology. Journal of Biomedical Engineering 1992; 14 (02) 91-107.
  • 15 Bai J, Bing Z. Simulation evaluation of cardiac assist device. Methods Inf Med 2000; 39: 191.
  • 16 Li X, Bai J, He P. Simulation study of the Hemopump as a cardiac assist device. Medical & Biological Engineering & Computing 2002; 40: 344.
  • 17 Sagawa K, Maughan L, Suga H, Sunagawa K. Cardiac contraction and the Pressure-Volume relationships. New York: Oxford University Press; 1988
  • 18 Suga H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am J Physiol 1979 236. (Heart Circ Physiol 5): H498-H505.
  • 19 Suga H. External mechanical work from relaxing ventricle. Am J Physiol 1979 236. (Heart Circ Physiol 5): H494-H497.
  • 20 De Lazzari C, Darowski M, Ferrari G, Tosti G, Pisanelli DM. The impact of Hemopump on ventricular energetic parameters when mechanical ventilation is applied: numerical simulation. Proceeding of the IASTED International Conference Biomedical Engineering. BioMED 2005; pp 279-83.
  • 21 Ursino M. Interaction between carotid baroregulation and the pulsating heart: a mathematical model. Am J Physiol Heart Circ Physiol 1998; 44: H1733.
  • 22 Magosso E, Cavalcanti S, Ursino M. Theoretical analysis of rest exercise hemodynamics in patients with total cavopulmonary connection. Am J Physiol Heart Circ Physiol 2002; 282: H1018.
  • 23 Snyder MF, Rideout VC. Computer simulation of the venous circulation. IEEE Transaction on Biomedical Engineering 1969; 16 (04) 325.
  • 24 Gilbert JC, Glantz SA. Determinants of left ventricular filling and of the diastolic pressure volume relation. Circ Res 1989; 64: 827.
  • 25 Guyton AC, Jones CE, Coleman TG. Computer analysis of total circulatory function and of cardiac output regulation. In: Circulatory Physiology: Cardiac Output and its Regulation.. Philadelphia: WB Saunders Company; 1973
  • 26 Lassard MR, Guerot E. et al Effects of pressurecontrolled with different I: E ratios versus volumecontrolled ventilation on respiratory mechanics, gas exchange, and hemodynamics in patients with adult respiratory distress syndrome. Anesthesiology 1994; 80 (05) 983-91.
  • 27 Chan K, Abraham E. Effects of inverse ratio ventilation on cardiorespiratory parameters in severe respiratory failure. Chest 1992; 102: 1556-61.
  • 28 Sternberg R, Sahebjami H. Hemodynamic and oxygen transport characteristics of common ventilatory modes. Chest 1994; 105 (06) 1789-803.
  • 29 Bayly R, Sladen A, Guntupalli K, Klain M. Synchronous versus nonsynchronous high-frequency jet ventilation: effects on cardiorespiratory variables and airway pressures in postoperative patients. Crit Care Med 1987; 15 (010) 915-7.
  • 30 Dries DJ, Kumar P, Mathru M, Mayer R, Zecca A, Rao TL, Freeark RJ. Hemodynamic effects of pressure support ventilation in cardiac surgery patients. Am Surg 1991; 57 (02) 122-5.
  • 31 Abraham E, Yoshihara G. Cardiorespiratory effects of pressure controlled ventilation in severe respiratory failure. Chest 1990; 98 (06) 1445-9.
  • 32 Poelaert JI, Visser CA, Everaert JA, Koolen JJ, Colardyn FA. Acute hemodynamic changes of pressure-controlled inverse ratio ventilation in the adult respiratory distress syndrome. A transesophageal echocardiographic and Doppler study. Chest 1993; 104: 214-9.
  • 33 Singer M, Vermaat J, Hall G, Latter G, Patel M. Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients. Chest 1994; 106 (04) 1182-7.
  • 34 Schuster S, Erbel R, Weilemann LS, Lu WY, Henkel B, Wellek S, Schinzel H, Myer J.. Hemodynamics during PEEP ventilation in patients with severe left ventricular failure studied by transesophageal echocardiography. Chest 1990; 97: 1181-9.
  • 35 Hartmann M, Rosberg B, Jonsson K. The influence of different levels of PEEP on peripheral tissue perfusion measured by subcutaneous and transcutaneous oxygen tension. Intensive Care Med 1992; 18 (08) 474-8.
  • 36 Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 1988; 69: 171.
  • 37 Dreyfus GD. Hemopump 31, the sternotomy Hemopump: clinical experience. Ann Thorac Surg 1996; 61: 323-8.
  • 38 Schima H, Vollkron M, Boehm H, Rothy W, Haisjackl M, Wieselthaler G, Wolner E. Weaning of rotary blood pump recipients after myocardial recovery: A computer study of changes in cardiac energetics. The Journal of Thoracic and Cardiovascular Surgery 2004 127. 6 1743
  • 39 Vollkron M, Schima H, Huber L, Wieselthaler G.. Interaction of the cardiovascular system with an implanted Rotary assist Device: simulation study with a refined computer model. Artificial Organs 2002; 26 (04) 349.
  • 40 Denault YA, Gorcsan J, Pinsky MR. Dynamic effects of positive-pressure ventilation on canine left ventricular pressure-volume relations. J Appl Physiol 2001; 91: 298.