Stochastic Modeling and Dynamic Analysis of the Cardiovascular System with Rotary Left Ventricular Assist Devices

摘要

Left ventricular assist devices (LVADs) have been used for end-stage heart failure patients as a therapeutic option. The aortic valve plays a critical role in heart failure and its treatment with a LVAD. The cardiovascular-LVAD model is often used to investigate the physiological demands required by patients and predict the hemodynamic of the native heart supported with a LVAD. As it is a bridge-to-recovery treatment, it is important to maintain appropriate and active dynamics of the aortic valve and the cardiac output of the native heart, which requires that the LVAD pump be adjusted so that a proper balance between the blood contributed through the aortic valve and the pump is maintained. In this paper, we investigate how the pump power of the LVAD pump can affect the dynamic behaviors of the aortic valve for different levels of activity and different severities of heart failure. Our objective is to identify a critical value of the pump power (i.e., breakpoint) to ensure that the LVAD pump does not take over the pumping function in the cardiovascular-pump system and share the ejected blood with the left ventricle to help the heart to recover. In addition, the hemodynamic often involves variability due to patients' heterogeneity and the stochastic nature of the cardiovascular system. The variability poses significant challenges to understanding dynamic behaviors of the aortic valve and cardiac output. A generalized polynomial chaos (gPC) expansion is used in this work to develop a stochastic cardiovascular-pump model for efficient uncertainty propagation, from which it is possible to rapidly calculate the variance in the aortic valve opening duration and the cardiac output in the presence of variability. The simulation results show that the gPC-based cardiovascular-pump model is a reliable platform that can provide useful information to understand the effect of the LVAD pump on the hemodynamic of the heart.