Study on modeling, simulation, and sensorless feedback control algorithm of the cavopulmonary assist device based on the subpulmonary ventricular exclusion_Journal of Biomedical Engineering

Authors：

PENG Jing ¹ , TAN Zhehuan ² , LUAN Yong ³ , QIN Kairong ¹ ,  WANG Yu ¹

1. School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian, Liaoning 116024, P.R.China;
2. Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria 3010, Australia;
3. Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R.China;

Corresponding author：

WANG Yu, Email: yuwang0410@dlut.edu.cn

Keywords：

Fontan circulation failure; cavopulmonary assist device; modeling and simulation; feedback control; cavopulmonary pressure head

DOI：

10.7507/1001-5515.202008005

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The subpulmonary ventricular exclusion (Fontan) could effectively improve the living quality for the children patients with a functional single ventricle in clinical. However, postoperative Fontan circulation failure can easily occur, causing obvious limitations while clinically implementing Fontan. The cavopulmonary assist devices (CPAD) is currently an effective means to solve such limitations. Therefore, in this paper the in-silico and in-vitro experiment coupled model of Fontan circulation failure for the children patients with a single ventricle and CPAD is established to evaluate the effects of CPAD on the Fontan circulation failure. Then a sensorless feedback control algorithm is proposed to provide sufficient cardiac output and prevent vena caval suction due to CPAD constant pump speed. Based on the CPAD pump speed-an intrinsic parameter, the sensorless feedback control algorithm could accurately estimate the cavopulmonary pressure head (CPPH) using extended Kalman filter, eliminating the disadvantage for pressure sensors that cannot be used in long term. And a gain-scheduled, proportional integral (PI) controller is used to make the actual CPPH approach to the reference value. Results show that the CPAD could effectively increase physiological perfusion for the children patients and reduce the workload of a single ventricle, and the sensorless feedback control algorithm can effectively guarantee cardiac output and prevent suction. This study can provide theoretical basis and technical support for the design and optimization of CPAD, and has potential clinical application value.

Citation： PENG Jing, TAN Zhehuan, LUAN Yong, QIN Kairong, WANG Yu. Study on modeling, simulation, and sensorless feedback control algorithm of the cavopulmonary assist device based on the subpulmonary ventricular exclusion. Journal of Biomedical Engineering, 2021, 38(3): 539-548. doi: 10.7507/1001-5515.202008005 Copy

1.	O’Leary P W. Prevalence, clinical presentation and natural history of patients with single ventricle. Prog Pediatr Cardiol, 2002, 16(1): 31-38.
2.	Granegger M, Thamsen B, Hubmann E J, et al. A long-term mechanical cavopulmonary support device for patients with Fontan circulation. Med Eng Phys, 2019, 70: 9-18.
3.	Gewillig M. The Fontan circulation. Heart, 2005, 91(6): 839-846.
4.	Goldberg D J, Shaddy R E, Ravishankar C, et al. The failing Fontan: etiology, diagnosis and management. Expert Rev Cardiovasc Ther, 2011, 9(6): 785-793.
5.	Kirklin J K, Pearce F B, Dabal R J, et al. Challenges of cardiac transplantation following the Fontan procedure. World J Pediatr Congenit Heart Surg, 2017, 8(4): 480-486.
6.	Simaan M A, Ferreira A, Chen S, et al. A dynamical state space representation and performance analysis of a feedback-controlled rotary left ventricular assist device. IEEE Trans Control Syst Technol, 2009, 17(1): 15-28.
7.	de Leval M R, Kilner P, Gewillig M, et al. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations: experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988, 96(5): 682-695.
8.	袁海云, 陈寄梅, 庄建. Fontan 循环腔-肺辅助装置的研究进展. 中国胸心血管外科临床杂志, 2016, 23(7): 728-731.
9.	Restrepo M, Tang E, Haggerty C M, et al. Energetic implications of vessel growth and flow changes over time in Fontan patients. Ann Thorac Surg, 2015, 99(1): 163-170.
10.	Kansy A, Brzezińska-Rajszys G, Zubrzycka M, et al. Pulmonary artery growth in univentricular physiology patients. Kardiol Pol, 2013, 71(6): 581-587.
11.	Rodefeld M D, Boyd J H, Myers C D, et al. Cavopulmonary assist: circulatory support for the univentricular Fontan circulation. Ann Thorac Surg, 2003, 76(6): 1911-1916.
12.	Rodefeld M D, Coats B, Fisher T, et al. Cavopulmonary assist for the univentricular Fontan circulation: von Kármán viscous impeller pump. J Thorac Cardiovasc Surg, 2010, 140(3): 529-536.
13.	Haggerty C M, Fynn-Thompson F, Mcelhinney D B, et al. Experimental and numeric investigation of impella pumps as cavopulmonary assistance for a failing Fontan. J Thorac Cardiovasc Surg, 2012, 144(3): 563-569.
14.	Mackling T, Shah T, Dimas V, et al. Management of single-ventricle patients with Berlin heart EXCOR ventricular assist device: single-center experience. Artif Organs, 2012, 36(6): 555-559.
15.	Giridharan G A, Koenig S C, Kennington J, et al. Performance evaluation of a pediatric viscous impeller pump for Fontan cavopulmonary assist. J Thorac Cardiovasc Surg, 2013, 145(1): 249-257.
16.	Rodefeld M D, Marsden A, Figliola R, et al. Cavopulmonary assist: long-term reversal of the Fontan paradox. J Thorac Cardiovasc Surg, 2019, 158(6): 1627-1636.
17.	Vollkron M, Schima H, Huber L, et al. Development of a suction detection system for axial blood pumps. Artif Organs, 2004, 28(8): 709-716.
18.	Giridharan G A, Ising M, Sobieski M, et al. Cavopulmonary assist for the failing Fontan circulation: impact of ventricular function on mechanical support strategy. ASAIO J, 2014, 60(6): 707-715.
19.	Di Molfetta A, Ferrari G, Filippelli S, et al. Use of ventricular assist device in univentricular physiology: the role of lumped parameter models. Artif Organs, 2016, 40(5): 444-453.
20.	Gandolfo F, Brancaccio G, Donatiello S, et al. Mechanically assisted total cavopulmonary connection with an axial flow pump: computational and in vivo study. Artif Organs, 2016, 40(1): 43-49.
21.	Chopski S G, Fox C S, Mckenna K L, et al. Physics-driven impeller designs for a novel intravascular blood pump for patients with congenital heart disease. Med Eng Phys, 2016, 38(7): 622-632.
22.	Wang Yu, Koenig S C, Wu Z J, et al. Sensorless physiologic control, suction prevention, and flow balancing algorithm for rotary biventricular assist devices. IEEE Trans Control Syst Technol, 2019, 27(2): 717-729.
23.	Granegger M, Schweiger M, Schmid D M, et al. Cavopulmonary mechanical circulatory support in Fontan patients and the need for physiologic control: a computational study with a closed-loop exercise model. Int J Artif Organs, 2018, 41(5): 261-268.
24.	Yamada A, Shiraishi Y, Miura H, et al. Development of a thermodynamic control system for the Fontan circulation pulsation device using shape memory alloy fibers. J Artif Organs, 2015, 18(3): 199-205.
25.	Pauls J P, Stevens M C, Schummy E, et al. In vitro comparison of active and passive physiological control systems for biventricular assist devices. Ann Biomed Eng, 2016, 44(5): 1370-1380.
26.	Kilic A, Katz J N, Joseph S M, et al. Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring. ESC Heart Fail, 2019, 6(1): 138-145.
27.	Giridharan G A, Skliar M, Olsen D B, et al. Modeling and control of a brushless DC axial flow ventricular assist device. ASAIO J, 2002, 48(3): 272-289.
28.	Ohuchi H. Where is the “optimal” Fontan hemodynamics?. Korean Circ J, 2017, 47(6): 842-857.
29.	Egbe A C, Connolly H M, Miranda W R, et al. Hemodynamics of Fontan failure. Circ Heart Fail, 2017, 10(12): e004515.
30.	Mori M, Hebson C, Shioda K, et al. Catheter-measured hemodynamics of adult Fontan circulation: associations with adverse event and end-organ dysfunctions. Congenit Heart Dis, 2016, 11(6): 589-597.
31.	Choi S, Boston J R, Thomas D, et al. Modeling and identification of an axial flow blood pump//Proceedings of the 1997 American Control Conference. Albuquerque: IEEE, 1997: 3714-3715.
32.	Pillay P, Krishnan R M. Simulation and analysis of permanent-magnet motor drives, part II: the brushless DC motor drive. IEEE Trans Ind Appl, 1989, 25(2): 274-279.
33.	Picard J. Efficiency of the extended Kalman filter for nonlinear systems with small noise. SIAM J Appl Math, 1991, 51(3): 843-885.
34.	Savitzky A, Golay M J E. Smoothing and differentiation of data by simplified least squares procedures. Anal Chem, 1964, 36(8): 1627-1639.
35.	Goldberg D J, French B, Mcbride M G, et al. Impact of oral sildenafil on exercise performance in children and young adults after the Fontan operation: a randomized, double-blind, placebo-controlled, crossover trial. Circulation, 2011, 123(11): 1185-1193.
36.	Kanter K R, Haggerty C M, Restrepo M, et al. Preliminary clinical experience with a bifurcated Y-graft Fontan procedure-a feasibility study. J Thorac Cardiovasc Surg, 2012, 144(2): 383-389.
37.	Anderson P A, Sleeper L A, Mahony L, et al. Contemporary outcomes after the Fontan procedure: a pediatric heart network multicenter study. J Am Coll Cardiol, 2008, 52(2): 85-98.
38.	Rodefeld M D, Boyd J H, Myers C D, et al. Cavopulmonary assist in the neonate: an alternative strategy for single-ventricle palliation. J Thorac Cardiovasc Surg, 2004, 127(3): 705-711.

1. O’Leary P W. Prevalence, clinical presentation and natural history of patients with single ventricle. Prog Pediatr Cardiol, 2002, 16(1): 31-38.
2. Granegger M, Thamsen B, Hubmann E J, et al. A long-term mechanical cavopulmonary support device for patients with Fontan circulation. Med Eng Phys, 2019, 70: 9-18.
3. Gewillig M. The Fontan circulation. Heart, 2005, 91(6): 839-846.
4. Goldberg D J, Shaddy R E, Ravishankar C, et al. The failing Fontan: etiology, diagnosis and management. Expert Rev Cardiovasc Ther, 2011, 9(6): 785-793.
5. Kirklin J K, Pearce F B, Dabal R J, et al. Challenges of cardiac transplantation following the Fontan procedure. World J Pediatr Congenit Heart Surg, 2017, 8(4): 480-486.
6. Simaan M A, Ferreira A, Chen S, et al. A dynamical state space representation and performance analysis of a feedback-controlled rotary left ventricular assist device. IEEE Trans Control Syst Technol, 2009, 17(1): 15-28.
7. de Leval M R, Kilner P, Gewillig M, et al. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations: experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988, 96(5): 682-695.
8. 袁海云, 陈寄梅, 庄建. Fontan 循环腔-肺辅助装置的研究进展. 中国胸心血管外科临床杂志, 2016, 23(7): 728-731.
9. Restrepo M, Tang E, Haggerty C M, et al. Energetic implications of vessel growth and flow changes over time in Fontan patients. Ann Thorac Surg, 2015, 99(1): 163-170.
10. Kansy A, Brzezińska-Rajszys G, Zubrzycka M, et al. Pulmonary artery growth in univentricular physiology patients. Kardiol Pol, 2013, 71(6): 581-587.
11. Rodefeld M D, Boyd J H, Myers C D, et al. Cavopulmonary assist: circulatory support for the univentricular Fontan circulation. Ann Thorac Surg, 2003, 76(6): 1911-1916.
12. Rodefeld M D, Coats B, Fisher T, et al. Cavopulmonary assist for the univentricular Fontan circulation: von Kármán viscous impeller pump. J Thorac Cardiovasc Surg, 2010, 140(3): 529-536.
13. Haggerty C M, Fynn-Thompson F, Mcelhinney D B, et al. Experimental and numeric investigation of impella pumps as cavopulmonary assistance for a failing Fontan. J Thorac Cardiovasc Surg, 2012, 144(3): 563-569.
14. Mackling T, Shah T, Dimas V, et al. Management of single-ventricle patients with Berlin heart EXCOR ventricular assist device: single-center experience. Artif Organs, 2012, 36(6): 555-559.
15. Giridharan G A, Koenig S C, Kennington J, et al. Performance evaluation of a pediatric viscous impeller pump for Fontan cavopulmonary assist. J Thorac Cardiovasc Surg, 2013, 145(1): 249-257.
16. Rodefeld M D, Marsden A, Figliola R, et al. Cavopulmonary assist: long-term reversal of the Fontan paradox. J Thorac Cardiovasc Surg, 2019, 158(6): 1627-1636.
17. Vollkron M, Schima H, Huber L, et al. Development of a suction detection system for axial blood pumps. Artif Organs, 2004, 28(8): 709-716.
18. Giridharan G A, Ising M, Sobieski M, et al. Cavopulmonary assist for the failing Fontan circulation: impact of ventricular function on mechanical support strategy. ASAIO J, 2014, 60(6): 707-715.
19. Di Molfetta A, Ferrari G, Filippelli S, et al. Use of ventricular assist device in univentricular physiology: the role of lumped parameter models. Artif Organs, 2016, 40(5): 444-453.
20. Gandolfo F, Brancaccio G, Donatiello S, et al. Mechanically assisted total cavopulmonary connection with an axial flow pump: computational and in vivo study. Artif Organs, 2016, 40(1): 43-49.
21. Chopski S G, Fox C S, Mckenna K L, et al. Physics-driven impeller designs for a novel intravascular blood pump for patients with congenital heart disease. Med Eng Phys, 2016, 38(7): 622-632.
22. Wang Yu, Koenig S C, Wu Z J, et al. Sensorless physiologic control, suction prevention, and flow balancing algorithm for rotary biventricular assist devices. IEEE Trans Control Syst Technol, 2019, 27(2): 717-729.
23. Granegger M, Schweiger M, Schmid D M, et al. Cavopulmonary mechanical circulatory support in Fontan patients and the need for physiologic control: a computational study with a closed-loop exercise model. Int J Artif Organs, 2018, 41(5): 261-268.
24. Yamada A, Shiraishi Y, Miura H, et al. Development of a thermodynamic control system for the Fontan circulation pulsation device using shape memory alloy fibers. J Artif Organs, 2015, 18(3): 199-205.
25. Pauls J P, Stevens M C, Schummy E, et al. In vitro comparison of active and passive physiological control systems for biventricular assist devices. Ann Biomed Eng, 2016, 44(5): 1370-1380.
26. Kilic A, Katz J N, Joseph S M, et al. Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring. ESC Heart Fail, 2019, 6(1): 138-145.
27. Giridharan G A, Skliar M, Olsen D B, et al. Modeling and control of a brushless DC axial flow ventricular assist device. ASAIO J, 2002, 48(3): 272-289.
28. Ohuchi H. Where is the “optimal” Fontan hemodynamics?. Korean Circ J, 2017, 47(6): 842-857.
29. Egbe A C, Connolly H M, Miranda W R, et al. Hemodynamics of Fontan failure. Circ Heart Fail, 2017, 10(12): e004515.
30. Mori M, Hebson C, Shioda K, et al. Catheter-measured hemodynamics of adult Fontan circulation: associations with adverse event and end-organ dysfunctions. Congenit Heart Dis, 2016, 11(6): 589-597.
31. Choi S, Boston J R, Thomas D, et al. Modeling and identification of an axial flow blood pump//Proceedings of the 1997 American Control Conference. Albuquerque: IEEE, 1997: 3714-3715.
32. Pillay P, Krishnan R M. Simulation and analysis of permanent-magnet motor drives, part II: the brushless DC motor drive. IEEE Trans Ind Appl, 1989, 25(2): 274-279.
33. Picard J. Efficiency of the extended Kalman filter for nonlinear systems with small noise. SIAM J Appl Math, 1991, 51(3): 843-885.
34. Savitzky A, Golay M J E. Smoothing and differentiation of data by simplified least squares procedures. Anal Chem, 1964, 36(8): 1627-1639.
35. Goldberg D J, French B, Mcbride M G, et al. Impact of oral sildenafil on exercise performance in children and young adults after the Fontan operation: a randomized, double-blind, placebo-controlled, crossover trial. Circulation, 2011, 123(11): 1185-1193.
36. Kanter K R, Haggerty C M, Restrepo M, et al. Preliminary clinical experience with a bifurcated Y-graft Fontan procedure-a feasibility study. J Thorac Cardiovasc Surg, 2012, 144(2): 383-389.
37. Anderson P A, Sleeper L A, Mahony L, et al. Contemporary outcomes after the Fontan procedure: a pediatric heart network multicenter study. J Am Coll Cardiol, 2008, 52(2): 85-98.
38. Rodefeld M D, Boyd J H, Myers C D, et al. Cavopulmonary assist in the neonate: an alternative strategy for single-ventricle palliation. J Thorac Cardiovasc Surg, 2004, 127(3): 705-711.

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Study on modeling, simulation, and sensorless feedback control algorithm of the cavopulmonary assist device based on the subpulmonary ventricular exclusion

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