Interaction of the cardiovascular system with an implanted rotary assist device: simulation study with a refined computer model.

In recent years, implanted rotary pumps have achieved the level of extended clinical application including complete mobilization and physical exercise of the recipients. A computer model was developed to study the interaction between a continuous-flow pump and the recovering cardiovascular system, the effects of changing pre- and afterloads, and the possibilities for indirect estimation of hemodynamic parameters and pump control. A numerical model of the cardiovascular system using Matlab Simulink simulation software was established. Data of circulatory system modules were derived from patients, our own in vitro and in vivo experiments, and the literature. Special care was taken to simulate properly the dynamic pressure-volume characteristics of both left and right ventricle, the Frank-Starling behavior, and the impedance of the proximal vessels. Excellent correlation with measured data was achieved including pressure and flow patterns within the time domain, response to varying loads, and effects of previously observed pressure-flow hysteresis in rotary pumps. Potential energy, external work, pressure-volume area, and other derived heart work parameters could be calculated. The model offers the possibility to perform parameter variations to study the effects of changing patient condition and therapy and to display them with three-dimensional graphics (demonstrated with the effects on right ventricular work and efficiency). The presented model gives an improved understanding of the interaction between the pump and both ventricles. It can be used for the investigation of various clinical and control questions in normal and pathological conditions of the left ventricular assist device recipient.