Effects of control strategies of the left ventricular assist device on the cardiorenal hemodynamics: an in-vitro model study_Journal of Biomedical Engineering

Authors：

ZHANG Lukun ^1,2 ,  WANG Yu ^1,3

1. Central Hospital of Dalian University of Technology, Dalian, Liaoning 116021, P. R. China;
2. School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian, Liaoning 116024, P. R. China;
3. Faculty of Medicine, Dalian University of Technology, Dalian, Liaoning 116024, P. R. China;

Corresponding?author：

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

Keywords：

Left ventricular assist device; Mock circulation loop; Control strategy; Hemodynamics; In-vitro control

DOI：

10.7507/1001-5515.202603032

Video：

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To investigate the effects of different control strategies of the left ventricular assist device (LVAD) on the cardiorenal hemodynamics, this study establishes a mock circulation loop (MCL) incorporating the systemic and renal circulations. The platform reproduced the hemodynamic characteristics of heart failure in vitro with the LVAD support. Under the premise of the same mean support levels, differences in pressure, flow, and pulsatility between the aorta and renal artery were compared among four control strategies: constant-speed control, physiological control, square-wave pulsatile speed modulation and sine-wave pulsatile speed modulation. The results showed that both constant-speed control and physiological control could provide stable support, but the aortic pulse pressure was only 3 mm Hg, indicating a marked reduction in pulsatility. Square-wave pulsatile speed modulation and sine-wave pulsatile speed modulation increased pulse pressure to 10–33 mm Hg and improved surplus hemodynamic energy (SHE). Further analysis showed that under pulsatile modulation, the increase of SHE in the renal artery was greater than that in the aorta, reaching maximum gain ratios of 51.9 and 24.8, respectively, indicating that aortic pulsatility index may not fully reflect the end-organ perfusion and hemodynamic energy benefits. These findings may provide experimental evidence for the optimization of LVAD control strategies and reference for the end-organ hemodynamic assessment.

Citation： ZHANG Lukun, WANG Yu. Effects of control strategies of the left ventricular assist device on the cardiorenal hemodynamics: an in-vitro model study. Journal of Biomedical Engineering, 2026, 43(5): 1052-1058. doi: 10.7507/1001-5515.202603032 Copy

1.	Shahim B, Kapelios C J, Savarese G, et al. Global public health burden of heart failure: an updated review[J]. Card Fail Rev, 2023, 9: e11.
2.	Mehra M R, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device-final report[J]. N Engl J Med, 2019, 380(17): 1618-1627.
3.	Schmitto J D, Shaw S, Garbade J, et al. Fully magnetically centrifugal left ventricular assist device and long-term outcomes: the ELEVATE registry[J]. Eur Heart J, 2024, 45(8): 613-625.
4.	Mehra M R, Goldstein D J, Cleveland J C, et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial[J]. JAMA, 2022, 328(12): 1233-1242.
5.	Stapor M, Pilat A, Gackowski A, et al. Echo-guided left ventricular assist device speed optimisation for exercise maximisation[J]. Heart, 2022, 108(13): 1055-1062.
6.	Tanaka S, Nishinaka T, Umeki A, et al. Hemodynamic evaluation of asynchronous speed modulation of a continuous-flow left ventricular assist device in an acute-myocardial injury sheep model[J]. Ann Biomed Eng, 2024, 52(2): 364-375.
7.	Ali O, Arnold A C, Cysyk J, et al. HeartWare left ventricular assist device exercise hemodynamics with speed adjustment based on left ventricular filling pressures[J]. ASAIO J, 2024, 70(6): e82-e88.
8.	May-Newman K. A mathematical model of artificial pulse synchronization for the HeartMate3 left ventricular assist device[J]. ASAIO J, 2023, 69(3): 284-289.
9.	Bari? D. Why pulsatility still matters: a review of current knowledge[J]. Croat Med J, 2014, 55(6): 609-620.
10.	Zhou H, Jiang X, Ventikos Y. Role of blood flow in endothelial functionality: a review[J]. Front Cell Dev Biol, 2023, 11: 1259280.
11.	St?hr E J, Ji R, Mondellini G, et al. Pulsatility and flow patterns across macro- and microcirculatory arteries of continuous-flow left ventricular assist device patients[J]. J Heart Lung Transplant, 2023, 42(9): 1223-1232.
12.	Gambaro A, Lombardi G, Onorati F, et al. Heart, kidney and left ventricular assist device: a complex trio[J]. Eur J Clin Invest, 2021, 51(12): e13662.
13.	Tamayo-Gutierrez A, Ibrahim H N. The kidney in heart failure: the role of venous congestion[J]. Methodist DeBakey Cardiovasc J, 2022, 18(4): 4-10.
14.	Yogasundaram H, Chappell M C, Braam B, et al. Cardiorenal syndrome and heart failure-challenges and opportunities[J]. Can J Cardiol, 2019, 35(9): 1208-1219.
15.	Rangaswami J, Bhalla V, Blair J E A, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association[J]. Circulation, 2019, 139(16): e840-e878.
16.	Buryskova-Salajova K B, Malik J, Valerianova A. Cardiorenal syndromes and their role in water and sodium homeostasis[J]. Physiol Res, 2024, 73(2): 173-187.
17.	Savira F, Magaye R, Liew D, et al. Cardiorenal syndrome: multi-organ dysfunction involving the heart, kidney and vasculature[J]. Br J Pharmacol, 2020, 177(13): 2906-2922.
18.	Kumar S, Bogle R, Banerjee D. Why do young people with chronic kidney disease die early?[J]. World J Nephrol, 2014, 3(4): 143-155.
19.	Nair A, Lamba H. Left ventricular assist devices and renal ramifications[J]. J Am Heart Assoc, 2023, 12(3): e028450.
20.	Pretorius M, Chen A, Kimlinger M J, et al. Acute kidney injury and chronic kidney disease after left ventricular assist device placement[J]. JTCVS Open, 2025, 25: 190-199.
21.	Garcia L P, Walther C P. Kidney health and function with left ventricular assist devices[J]. Curr Opin Nephrol Hypertens, 2023, 32(5): 439-444.
22.	Walther C P, Benoit J S, Lamba H K, et al. Distinctive kidney function trajectories following left ventricular assist device implantation[J]. J Heart Lung Transplant, 2022, 41(12): 1798-1807.
23.	Roehm B, Hedayati S, Vest A R, et al. Long-term changes in estimated glomerular filtration rate in left ventricular assist device recipients: a longitudinal joint model analysis[J]. J Am Heart Assoc, 2023, 12(3): e025993.
24.	Cappon F, Wu T, Papaioannou T, et al. Mock circulatory loops used for testing cardiac assist devices: a review of computational and experimental models[J]. Int J Artif Organs, 2021, 44(11): 793-806.
25.	Agrafiotis E, Zimpfer D, M?chler H, et al. Review of systemic mock circulation loops for evaluation of implantable cardiovascular devices and biological tissues[J]. J Endovasc Ther, 2025, 32(5): 1278-1300.
26.	Lu P, Chan M, Tsui S, et al. Development of an anatomy-mimicking, wave transport-preserving mock circulation loop for evaluating pulsatile hemodynamics as supported by cardiovascular assist devices[J]. Cardiovasc Eng Technol, 2025, 16(4): 435-454.
27.	Xu K, Gao Q, Wan M, et al. Mock circulatory loop applications for testing cardiovascular assist devices and in vitro studies[J]. Front Physiol, 2023, 14: 1175919.
28.	Gehron J, Zirbes J, Bongert M, et al. Development and validation of a life-sized mock circulatory loop of the human circulation for fluid-mechanical studies[J]. ASAIO J, 2019, 65(8): 788-797.
29.	Westerhof N, Lankhaar J W, Westerhof B E. The arterial Windkessel[J]. Med Biol Eng Comput, 2009, 47(2): 131-141.
30.	Brindise M C, Busse M M, Vlachos P P. Density and viscosity matched Newtonian and non-Newtonian blood-analog solutions with PDMS refractive index[J]. Exp Fluids, 2018, 59(11): 173.
31.	Barua S, Stevens M, Jain P, et al. A mock circulatory loop analysis of cardiorenal hemodynamics with intra-aortic mechanical circulatory support[J]. ASAIO J, 2025, 71(2): 128-135.
32.	Hall J E, Hall M E. Guyton and Hall textbook of medical physiology[M]. 15th ed. Philadelphia: Elsevier, 2025.
33.	Avrahami I, Kersh D, Liberzon A. Pulsatility index as a diagnostic parameter of reciprocating wall shear stress parameters in physiological pulsating waveforms[J]. PLoS One, 2016, 11(11): e0166426.
34.	Undar A, Zapanta C M, Reibson J D, et al. Precise quantification of pressure flow waveforms of a pulsatile ventricular assist device in an adult mock loop system[J]. ASAIO J, 2005, 51(1): 56-59.
35.	Kayali F, Tahhan O, Vecchio G, et al. Left ventricular unloading to facilitate ventricular remodelling in heart failure: a narrative review of mechanical circulatory support[J]. Exp Physiol, 2024, 109(11): 1826-1836.
36.	Belkin M N, Kagan V, Labuhn C, et al. Physiology and clinical utility of HeartMate pump parameters[J]. J Card Fail, 2022, 28(5): 845-862.
37.	Eisen H J, Flack J M, Atluri P, et al. Management of hypertension in patients with ventricular assist devices: a scientific statement from the American Heart Association[J]. Circ Heart Fail, 2022, 15(5): e000074.
38.	Wang Y, Koenig S C, Sobieski M A, et al. Hemodynamic benefits of counterpulsation, implantable, percutaneous, and intraaortic rotary blood pumps: an in-silico and in vitro study[J]. Cardiovasc Eng Technol, 2017, 8(4): 439-452.
39.	Tan Z, Huo M, Qin K, et al. A sensorless, physiologic feedback control strategy to increase vascular pulsatility for rotary blood pumps[J]. Biomed Signal Process Control, 2023, 83(20): 104640.
40.	Wang Y, Peng J, Qin K, et al. Control strategy to enhance pulmonary vascular pulsatility for implantable cavopulmonary assist devices: a simulation study[J]. Biomed Signal Process Control, 2021, 70(1): 103008.

1. Shahim B, Kapelios C J, Savarese G, et al. Global public health burden of heart failure: an updated review[J]. Card Fail Rev, 2023, 9: e11.
2. Mehra M R, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device-final report[J]. N Engl J Med, 2019, 380(17): 1618-1627.
3. Schmitto J D, Shaw S, Garbade J, et al. Fully magnetically centrifugal left ventricular assist device and long-term outcomes: the ELEVATE registry[J]. Eur Heart J, 2024, 45(8): 613-625.
4. Mehra M R, Goldstein D J, Cleveland J C, et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial[J]. JAMA, 2022, 328(12): 1233-1242.
5. Stapor M, Pilat A, Gackowski A, et al. Echo-guided left ventricular assist device speed optimisation for exercise maximisation[J]. Heart, 2022, 108(13): 1055-1062.
6. Tanaka S, Nishinaka T, Umeki A, et al. Hemodynamic evaluation of asynchronous speed modulation of a continuous-flow left ventricular assist device in an acute-myocardial injury sheep model[J]. Ann Biomed Eng, 2024, 52(2): 364-375.
7. Ali O, Arnold A C, Cysyk J, et al. HeartWare left ventricular assist device exercise hemodynamics with speed adjustment based on left ventricular filling pressures[J]. ASAIO J, 2024, 70(6): e82-e88.
8. May-Newman K. A mathematical model of artificial pulse synchronization for the HeartMate3 left ventricular assist device[J]. ASAIO J, 2023, 69(3): 284-289.
9. Bari? D. Why pulsatility still matters: a review of current knowledge[J]. Croat Med J, 2014, 55(6): 609-620.
10. Zhou H, Jiang X, Ventikos Y. Role of blood flow in endothelial functionality: a review[J]. Front Cell Dev Biol, 2023, 11: 1259280.
11. St?hr E J, Ji R, Mondellini G, et al. Pulsatility and flow patterns across macro- and microcirculatory arteries of continuous-flow left ventricular assist device patients[J]. J Heart Lung Transplant, 2023, 42(9): 1223-1232.
12. Gambaro A, Lombardi G, Onorati F, et al. Heart, kidney and left ventricular assist device: a complex trio[J]. Eur J Clin Invest, 2021, 51(12): e13662.
13. Tamayo-Gutierrez A, Ibrahim H N. The kidney in heart failure: the role of venous congestion[J]. Methodist DeBakey Cardiovasc J, 2022, 18(4): 4-10.
14. Yogasundaram H, Chappell M C, Braam B, et al. Cardiorenal syndrome and heart failure-challenges and opportunities[J]. Can J Cardiol, 2019, 35(9): 1208-1219.
15. Rangaswami J, Bhalla V, Blair J E A, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association[J]. Circulation, 2019, 139(16): e840-e878.
16. Buryskova-Salajova K B, Malik J, Valerianova A. Cardiorenal syndromes and their role in water and sodium homeostasis[J]. Physiol Res, 2024, 73(2): 173-187.
17. Savira F, Magaye R, Liew D, et al. Cardiorenal syndrome: multi-organ dysfunction involving the heart, kidney and vasculature[J]. Br J Pharmacol, 2020, 177(13): 2906-2922.
18. Kumar S, Bogle R, Banerjee D. Why do young people with chronic kidney disease die early?[J]. World J Nephrol, 2014, 3(4): 143-155.
19. Nair A, Lamba H. Left ventricular assist devices and renal ramifications[J]. J Am Heart Assoc, 2023, 12(3): e028450.
20. Pretorius M, Chen A, Kimlinger M J, et al. Acute kidney injury and chronic kidney disease after left ventricular assist device placement[J]. JTCVS Open, 2025, 25: 190-199.
21. Garcia L P, Walther C P. Kidney health and function with left ventricular assist devices[J]. Curr Opin Nephrol Hypertens, 2023, 32(5): 439-444.
22. Walther C P, Benoit J S, Lamba H K, et al. Distinctive kidney function trajectories following left ventricular assist device implantation[J]. J Heart Lung Transplant, 2022, 41(12): 1798-1807.
23. Roehm B, Hedayati S, Vest A R, et al. Long-term changes in estimated glomerular filtration rate in left ventricular assist device recipients: a longitudinal joint model analysis[J]. J Am Heart Assoc, 2023, 12(3): e025993.
24. Cappon F, Wu T, Papaioannou T, et al. Mock circulatory loops used for testing cardiac assist devices: a review of computational and experimental models[J]. Int J Artif Organs, 2021, 44(11): 793-806.
25. Agrafiotis E, Zimpfer D, M?chler H, et al. Review of systemic mock circulation loops for evaluation of implantable cardiovascular devices and biological tissues[J]. J Endovasc Ther, 2025, 32(5): 1278-1300.
26. Lu P, Chan M, Tsui S, et al. Development of an anatomy-mimicking, wave transport-preserving mock circulation loop for evaluating pulsatile hemodynamics as supported by cardiovascular assist devices[J]. Cardiovasc Eng Technol, 2025, 16(4): 435-454.
27. Xu K, Gao Q, Wan M, et al. Mock circulatory loop applications for testing cardiovascular assist devices and in vitro studies[J]. Front Physiol, 2023, 14: 1175919.
28. Gehron J, Zirbes J, Bongert M, et al. Development and validation of a life-sized mock circulatory loop of the human circulation for fluid-mechanical studies[J]. ASAIO J, 2019, 65(8): 788-797.
29. Westerhof N, Lankhaar J W, Westerhof B E. The arterial Windkessel[J]. Med Biol Eng Comput, 2009, 47(2): 131-141.
30. Brindise M C, Busse M M, Vlachos P P. Density and viscosity matched Newtonian and non-Newtonian blood-analog solutions with PDMS refractive index[J]. Exp Fluids, 2018, 59(11): 173.
31. Barua S, Stevens M, Jain P, et al. A mock circulatory loop analysis of cardiorenal hemodynamics with intra-aortic mechanical circulatory support[J]. ASAIO J, 2025, 71(2): 128-135.
32. Hall J E, Hall M E. Guyton and Hall textbook of medical physiology[M]. 15th ed. Philadelphia: Elsevier, 2025.
33. Avrahami I, Kersh D, Liberzon A. Pulsatility index as a diagnostic parameter of reciprocating wall shear stress parameters in physiological pulsating waveforms[J]. PLoS One, 2016, 11(11): e0166426.
34. Undar A, Zapanta C M, Reibson J D, et al. Precise quantification of pressure flow waveforms of a pulsatile ventricular assist device in an adult mock loop system[J]. ASAIO J, 2005, 51(1): 56-59.
35. Kayali F, Tahhan O, Vecchio G, et al. Left ventricular unloading to facilitate ventricular remodelling in heart failure: a narrative review of mechanical circulatory support[J]. Exp Physiol, 2024, 109(11): 1826-1836.
36. Belkin M N, Kagan V, Labuhn C, et al. Physiology and clinical utility of HeartMate pump parameters[J]. J Card Fail, 2022, 28(5): 845-862.
37. Eisen H J, Flack J M, Atluri P, et al. Management of hypertension in patients with ventricular assist devices: a scientific statement from the American Heart Association[J]. Circ Heart Fail, 2022, 15(5): e000074.
38. Wang Y, Koenig S C, Sobieski M A, et al. Hemodynamic benefits of counterpulsation, implantable, percutaneous, and intraaortic rotary blood pumps: an in-silico and in vitro study[J]. Cardiovasc Eng Technol, 2017, 8(4): 439-452.
39. Tan Z, Huo M, Qin K, et al. A sensorless, physiologic feedback control strategy to increase vascular pulsatility for rotary blood pumps[J]. Biomed Signal Process Control, 2023, 83(20): 104640.
40. Wang Y, Peng J, Qin K, et al. Control strategy to enhance pulmonary vascular pulsatility for implantable cavopulmonary assist devices: a simulation study[J]. Biomed Signal Process Control, 2021, 70(1): 103008.

Journal of Biomedical Engineering

Effects of control strategies of the left ventricular assist device on the cardiorenal hemodynamics: an in-vitro model study

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