Left ventricular assist devices (LVADs) can provide mechanical support for a failing heart as a bridge to transplant and destination therapy. Physiological control systems for LVADs should be designed to respond to changes in hemodynamic across a variety of clinical scenarios and patients by automatically adjusting the heart pump speed. In this study, a novel adaptive physiological control system for an implantable heart pump was developed to respond to interpatient and intrapatient variations to maintain the left-ventricle-end-diastolic-pressure (LVEDP) in the normal range of 3 to 15 mmHg to prevent ventricle suction and pulmonary congestion. A new algorithm was also developed to detect LVEDP from pressure sensor measurement in real-time mode. Model-free adaptive control (MFAC) was employed to control the pump speed via simulation of 100 different patient conditions in each of six different patient scenarios, and compared to standard PID control. Controller performance was tracked using the sum of the absolute error (SAE) between the desired and measured LVEDP. The lower SAE on control tracking performance means that the measured LVEDP follows the desired LVEDP faster and with less amplitude oscillations, preventing ventricle suction and pulmonary congestion (mean and standard deviation of SAE (mmHg) for all 600 simulations were 18813 ± 29345 and 24794 ± 28380 corresponding to MFAC and PID controller, respectively). In four out of six patient scenarios, MFAC control tracking performance was better than the PID controller. This study shows the control performance can be guaranteed across different patients and conditions when using MFAC over PID control, which is a step toward clinical acceptance of these systems.

中文翻译：

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适用于患者间和患者内变化的植入式心脏泵的生理控制系统

左心室辅助装置 (LVAD) 可以为衰竭的心脏提供机械支持，作为移植和目的地治疗的桥梁。LVAD 的生理控制系统应设计为通过自动调节心脏泵速来响应各种临床情况和患者的血流动力学变化。在这项研究中，开发了一种用于植入式心脏泵的新型自适应生理控制系统，以响应患者间和患者内的变化，将左心室舒张末压 (LVEDP) 维持在 3 至 15 mmHg 的正常范围内，以防止心室抽吸和肺淤血。还开发了一种新算法，以实时模式从压力传感器测量中检测 LVEDP。无模型自适应控制 (MFAC) 用于通过模拟 6 种不同患者场景中的每一种中的 100 种不同患者状况来控制泵速度，并与标准 PID 控制进行比较。控制器性能使用所需和测量的 LVEDP 之间的绝对误差 (SAE) 之和进行跟踪。控制跟踪性能上的较低 SAE 意味着测得的 LVEDP 更快地遵循所需的 LVEDP 且幅度振荡较小，从而防止心室吸入和肺充血（所有 600 次模拟的 SAE (mmHg) 的平均值和标准偏差为 18813 ± 29345 和 24794 ± 28380 分别对应于 MFAC 和 PID 控制器）。在六分之四的患者场景中，MFAC 控制跟踪性能优于 PID 控制器。