Capoccia, M. | bioRxiv Science

bioRxiv2025

Modelling and simulation of the interactions between the cardiovascular system, VA ECMO and IABP: when is it an appropriate combination?

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) for the management of refractory cardiogenic shock (CS) has been widely used in recent years. Increased left ventricular (LV) afterload induced by retrograde flow remains a limiting factor, which is particularly evident during peripheral VA ECMO support. The concomitant use of the intra-aortic balloon pump (IABP) is an established strategy to achieve LV unloading during VA ECMO support. Nevertheless, there remains controversy about the combined use of IABP during central or peripheral VA ECMO in terms of beneficial effects and outcome. We developed a simulation setting to study left ventricular unloading with IABP during peripheral and central VA ECMO using CARDIOSIM(C), an established software simulator of the cardiovascular system. The aim was to quantitatively evaluate potential differences between the two VA ECMO configurations and ascertain the true beneficial effects compared to VA ECMO alone.

bioengineering↗

bioRxiv2024

The Role of TandemHeartTM combined with ProtekDuoTM as Right Ventricular Support Device: A Simulation Approach

Right ventricular failure increases short-term mortality in the setting of acute myocardial infarction, cardiogenic shock, advanced left-sided heart failure and pulmonary hypertension. Right ventricular failure remains quite a challenging condition to manage in view of its complex background and still incomplete understanding of its pathophysiology. Percutaneous and surgically implanted right ventricular assist devices (RVADs) have been investigated in different clinical settings. The use of the ProtekDuoTM (LivaNova, London, UK) is currently a promising approach due to its features such as groin-free approach leading to early mobilisation, easy percutaneous deployment, compatibility with different pumps and oxygenators, and adaptability to different configurations. The aim of this work was to simulate the behaviour of the TandemHeartTM pump applied "in series" and "in parallel" mode and the combination of TandemHeartTM and ProtekDuoTM cannula as right ventricular assist device using CARDIOSIM(C) software simulator platform. The effects induced on the main hemodynamic and energetic variables were analysed for both the right atrial-pulmonary arterial and right ventricular-pulmonary arterial configuration with different pump rotational speed and following of Milrinone administration. The TandemHeartTM increased right ventricular end systolic volume by 10%, larger increases were evident for higher speeds (6000 and 7500 rpm) and connections with 21 Fr inflow and 17 Fr outflow cannula, respectively. Both TandemHeartTM and ProtekDuoTM support increased left ventricular preload. When different RVAD settings were used, Milrinone therapy increased the left ventricular pressure-volume area and decreased the right pressure-volume area slightly. A reduction in oxygen consumption (demand) was observed with reduced right stroke work and pressure volume area and increased oxygen supply (coronary blood flow).

bioengineering↗