First clinical experience with an automatic control system for rotary blood pumps during ergometry and right-heart catheterization.
BACKGROUND
At present, most clinically implanted rotary blood pumps are operated at constant speed and adjusted by the physician. It is generally assumed that an adaptation of pump speed to the patient's physiologic requirements would be beneficial. The data provided in this paper, based on hemodynamic and spirometric data during exercise in which a pre-load-sensitive control was used, lend quantitative support to this assumption.


METHODS
An automatic speed control was developed and implemented with Matlab on a dSpace controller board. The system uses pump speed, pump power, and pump flow as its only input signals. It was connected to the clinical hardware of the DeBakey VAD System. The control is pre-load-sensitive and uses an expert system to detect excessive unloading and eventual suction. This system was used to quantify the cardiovascular reaction of patients to both automatically controlled and constant pump speed. A sub-group of 5 patients underwent bicycle ergometry with Swan-Ganz catheterization and spiroergometry.


RESULTS
The automatic, closed-loop speed control showed robust and stable performance. It provided an increase in pump flow (+0.94 +/- 0.5 liters/min, p < 0.05) compared with constant-speed mode in response to physical activity. Pulmonary arterial (PAP) and capillary wedge pressure (PCWP) clearly decreased (-7.4 +/- 4.1 mm Hg for PAP and -8.3 +/- 4.2 mm Hg for PCWP, p < 0.05), and venous oxygen saturation moderately increased (+5.2%).


CONCLUSIONS
An automatic speed-control system for rotary blood pumps was developed and demonstrated by spiroergometry to be appropriately responsive to physiologic demand.
Schima
Heinrich
H
Department of Cardiothoracic Surgery and Ludwig Boltzmann Institute for Cardiosurgical Research, Medical University of Vienna, Vienna, Austria. heinrich.schima@meduniwien.ac.at
Vollkron
Michael
M
Jantsch
Ursula
U
Crevenna
Richard
R
Roethy
Wilfried
W
Benkowski
Robert
R
Morello
Gino
G
Quittan
Michael
M
Hiesmayr
Michael
M
Wieselthaler
Georg
G
D000465:Algorithms; D001331:Automation; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000502:physiology; D002320:Cardiovascular Physiological Phenomena; D004867:Equipment Design; D016552:Ergometry; D006339:Heart Rate / Q000502:physiology; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D012143:Respiratory Physiological Phenomena; D013147:Spirometry