发表机构
Universidade de São Paulo; Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo（圣保罗大学; 圣保罗大学医学院心脏研究所临床医院）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
本研究提出一种基于压力测量的集成系统架构，用于连续流心室辅助装置的生理控制，通过动态转速调整优化交互，在27个模拟场景中消除抽吸和反流事件，改善血流动力学和代谢指标，为体外验证奠定基础。
AI 中文摘要
本研究介绍了用于连续流心室辅助装置（VAD）生理控制的集成系统架构（ISA）的开发及在体计算机模拟评估。该系统采用基于VAD流入插管处压力测量的自动控制器，以估算心率和心室充盈压，从而实现动态转速调整，优化VAD与患者之间的交互。评估涵盖了27个模拟场景，从四个方面进行考察：运行转速调节、对可变需求的响应性、不良事件缓解及生理影响。控制器持续适应前负荷、后负荷和心率，通过相对于基线（6000 rpm）从-10%（-600 rpm）到+43%（+2600 rpm）的转速调整来满足流量需求。此外，动态调节消除了心室抽吸和反流事件，而这些事件在27个未控制场景中的12个中曾被观察到。血流动力学和代谢结果显示，左心室射血分数提高（+6.23%至+62.31%），射血功减少（-1658.64至-206.37 mmHg*mL），压力-容积环面积减小（-9485.17至-1056.05 mmHg*mL），心肌耗氧量降低（-20.5至-1.14 mL/min）。同时，总氧输送量增加（+56.9至+626.23 mL/min），心脏功率增加（+100至+3070 mW）。这些发现表明，ISA成功维持了生理调节并缓解了不良事件，为未来的体外验证奠定了坚实基础。
英文摘要
This study presents the development and in silico evaluation of an Integrated System Architecture (ISA) for the physiological control of continuous-flow ventricular assist devices (VADs). The system employs an automatic controller based on pressure measurements at the VAD inflow cannula to estimate heart rate and ventricular filling pressure, enabling dynamic speed adjustments that optimize VAD-patient interaction. The evaluation encompassed 27 simulation scenarios assessing four aspects: operating speed regulation, responsiveness to variable demand, adverse event mitigation, and physiological impact. The controller continuously adapted to preload, afterload, and heart rate, accommodating flow demands with speed adjustments ranging from -10% (-600 rpm) to +43% (+2,600 rpm) relative to the baseline (6,000 rpm). Furthermore, dynamic regulation eliminated ventricular suction and backflow events, which were previously observed in 12 of the 27 uncontrolled scenarios. Hemodynamic and metabolic outcomes demonstrated improved left ventricular ejection fraction (+6.23% to +62.31%), reduced ejection work (-1,658.64 to -206.37 mmHg*mL), decreased pressure-volume loop area (-9,485.17 to -1,056.05 mmHg*mL), and reduced myocardial oxygen consumption (-20.5 to -1.14 mL/min). Concurrently, total oxygen delivery increased (+56.9 to +626.23 mL/min) along with cardiac power (+100 to +3,070 mW). These findings demonstrate that the ISA successfully maintains physiological regulation and mitigates adverse events, establishing a solid foundation for future in vitro validation.
