Evaluation of centrifugal blood pump performances for biventricular support in the virtual simulation model

Background Despite the advances in the left ventricular assist device (LVAD), there are still situations that require a biventricular assist device (BVAD) system. The purpose of this study was to explore and compare the system performance interactions with the HeartMate3 (HM3) and HeartWare (HVAD) in a BVAD configuration using the virtual mock loop (VML) simulation tool. Methods The VML simulation tool is an in silico implementation of a lumped parameter model of the cardiovascular system with mechanical circulatory support. Patients with ejection fractions of 60%, 20%, and 15% were simulated in VML, and the HVAD and HM3 in a BVAD with ventricular cannulation were applied to simulated conditions. Pump speeds that restored baseline normal hemodynamics were determined. To determine the optimal speeds for BVAD, the left and right arterial pressures (LAP, RAP) were plotted. Results In the HVAD, LAP and RAP are balanced at 11 mm Hg with LVAD 3500 rpm, right ventricular assist device (RVAD) 2200 rpm; at 13 mm Hg with LVAD 3000 rpm, RVAD 1700 rpm; and at 14 mm Hg with LVAD 2500 rpm, RVAD 1300 rpm. For the HM3, at 8 mm Hg with LVAD 7000 rpm, RVAD 5000 rpm; at 9 mm Hg with LVAD 6000 rpm, RVAD 4300 rpm; and at 9.5 mm Hg with LVAD 5000 rpm, RVAD 3500 rpm. Conclusion The RVAD/LVAD speed ratios required for atrial balance were approximately 0.6 for the HVAD and 0.7 for the HM3. However, the HVAD required RVAD speeds below its range of operation. The biventricular support in the HeartWare and HeartMate 3 were simulated with the in silico simulation model, The Virtual Mock Loop. The model was feasible for the simulation of pumps in the biventricular support configuration and described the left and right balance of the pumps.