In-Series Versus In-Parallel Mechanical Circulatory Support for the Right Heart: A Simulation Study.
Right heart failure (RHF) is a serious health issue with increasing incidence and high mortality. Right ventricular assist devices (RVADs) have been used to support the end-stage failing right ventricle (RV). Current RVADs operate in parallel with native RV, which alter blood flow pattern and increase RV afterload, associated with high tension in cardiac muscles and long-term valve complications. We are developing an in-series RVAD for better RV unloading. This article presents a mathematical model to compare the effects of RV unloading and hemodynamic restoration on an overloaded or failing RV. The model was used to simulate both in-series (sRVAD) and in-parallel (pRVAD) (right atrium-pulmonary artery cannulation) support for severe RHF. The results demonstrated that sRVAD more effectively unloads the RV and restores the balance between RV oxygen supply and demand in RHF patients. In comparison to simulated pRVAD and published clinical and in silico studies, the sRVAD was able to provide comparable restoration of key hemodynamic parameters and demonstrated superior afterload and volume reduction. This study concluded that in-series support was able to produce effective afterload reduction and preserve the valve functionality and native blood flow pattern, eliminating complications associated with in-parallel support.
Artificial Organs Technology Laboratory, Biomanufacturing Centre, Soochow University, Suzhou, Jiangsu, China.
Po-Lin
PL
Hsu
Department of Cardiovascular Engineering, Institute for Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
Madeleine
M
McIntyre
Department of Cardiovascular Engineering, Institute for Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
Fiete
F
Boehning
Artificial Organs Technology Laboratory, Biomanufacturing Centre, Soochow University, Suzhou, Jiangsu, China.
Weiguo
W
Dang
Department of Cardiothoracic and Vascular Surgery, University Hospital Aachen, Aachen, Germany.
Jack
J
Parker
Department of Cardiothoracic and Vascular Surgery, University Hospital Aachen, Aachen, Germany.
Rüdiger
R
Autschbach
Department of Cardiovascular Engineering, Institute for Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
Thomas
T
Schmitz-Rode
Department of Cardiovascular Engineering, Institute for Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
Ulrich
U
Steinseifer
D001243:Assisted Circulation / Q000295:instrumentation*; D003198:Computer Simulation; D004867:Equipment Design; D006333:Heart Failure / Q000503:physiopathology* / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008955:Models, Cardiovascular
Lumped parameter model; Mechanical circulatory support; Right heart failure; Right ventricular assist device