Less invasive approach to automated closed-loop control of hemodynamics in decompensated heart failure

Abstract: We have been developing a computer-controlled infusion system of cardiovascular drugs (vasodilator, inotropes, diuretics, volume-expander) to automatically optimize arterial pressure (AP), cardiac output (CO), and pulmonary wedge pressure (PCWP) in heart failure (HF). In our previous developments, however, CO and PCWP were measured through thoracotomy, and inotropes were inevitably infused, which were clinically impractical or not in line with HF guidelines. We have made the system less invasive and clinically feasible. CO and PCWP were estimated and monitored less-invasively utilizing transthoracic-echocardiography. Control algorithm was revised in accordance with the guidelines. We applied the system to 9 HF dogs. Once activated, our system immediately started infusions of vasodilator/diuretics in all animals. Inotropes was not used in 3, and used at minimal doses in 6 animals that were intolerant of vasodilators. Hemodynamic variables were controlled to their targets accurately. In conclusion, the advanced system may be useful in managing patients with HF.