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Background: Maintaining balanced left and right cardiac outputs in a total artificial heart (TAH) is challenging due to the need for continuous adaptation to changing hemodynamic conditions. Proper balance in ventricular outputs of the left and right ventricles requires a preload‐sensitive response and mechanisms to address the higher volumetric efficiency of the right ventricle. Methods: This review provides a comprehensive overview of various methods used to balance left and right ventricular outputs in pulsatile total artificial hearts, categorized based on their actuation mechanism. Results: Reported strategies include incorporating compliant materials and/or air cushions inside the ventricles, employing active control mechanisms to regulate ventricular filling state, and utilizing various shunts (such as hydraulic or intra‐atrial shunts). Furthermore, reducing right ventricular stroke volume compared to the left often serves to balance the ventricular outputs. Individually controlled actuation of both ventricles in a pulsatile TAH seems to be the simplest and most effective way to achieve proper preload sensitivity and left–right output balance. Pneumatically actuated TAHs have the advantage to respond passively to preload changes. Conclusion: Therefore, a pneumatic TAH that comprises two individually actuated ventricles appears to be a more desirable option—both in terms of simplicity and efficacy—to respond to changing hemodynamic conditions. [ABSTRACT FROM AUTHOR]

Implanting rotary blood pumps (RBPs) has become the principal treatment for patients suffering from severe heart failure. There are still many challenges to address for RBP control systems. These problems include meeting the patient’s physiological perfusion, eliminating postoperative complications, as well as debugging the patient’s physiological control system (automatically and indiscriminately). This paper proposes a non-invasive adaptive control system based on the Frank–Starling-like mechanism (NAC-FSL) to solve these problems. This control system uses the motor speed of the rotary blood pump as the only input variable, and the pump flow was estimated by the motor speed for achieving non-invasive detection. Simultaneously, a cardiovascular reference model was developed to provide an appropriate real-time preload for heart failure patients. The Frank–Starling-like control baseline was tracked to obtain the desired reference average pump flow by using the preload. Avoiding suction was done by adopting the control baseline (CLn), which included a flat slope under a high preload. Moreover, the NAC-FSL system could potentially unload the left ventricle and provide a higher pump flow with a smaller error during the exercise state, as compared to the CSC system. Finally, the K value indicating the preload sensitivity in the NAC-FSL controller was optimized to meet the perfusion needs according to the hemodynamic parameters.

Responses of five rotary blood pumps, namely HeartAssist 5, HeartMate II, HeartWare, Sputnik 1, and Sputnik 2, were extensively assessed in six test cases using a mathematical model of the cardiovascular system. Data for the rotary pumps were derived from pressure-flow curves reported in the literature. The test cases were chosen to attempt to cover most common clinical conditions, such as partial or full support or transitions between different levels of ventricular support. The investigated parameters are collected in a table and presented in figures, such as pressure-volume loops, H-Q curves, pump flow, and aortic pressure waveforms. HeartAssist, Sputnik 1, and Sputnik 2 pumps provide comparable level of aortic pressure, pump flow pulsatility PI(Q P ), and aortic pressure pulsatility PI(AoP) due to the similarity of pressure-flow characteristic curves of these pumps. HeartMate II provides a minimal backflow among other investigated rotary blood pumps due to the maximum pressure head at zero flow. HeartWare provides minimal pulsation of flow, which is confirmed by a flow range from -2 to 7 L/min in case 1. At the same time, the greatest degree of unloading was demonstrated by the HeartWare due to the flatness of the pressure-flow curve shape. The conclusions were made based on the obtained results, including the influence of pressure-flow curve shape on the pump performance and occurrences of adverse events, such as backflow or suction. For example, the increase of the pressure head at zero flow decreases the likelihood of backflow through the pump, and with it, increasing the flow under minimal pressure head increases the likelihood of suction.