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Simulated Performance of the Cleveland Clinic Continuous-Flow Total Artificial Heart Using the Virtual Mock Loop

Miyamoto, Takuma*; Horvath, David J.; Horvath, Dennis W.; Karimov, Jamshid H.*; Byram, Nicole*; Kuban, Barry D.*,‡; Fukamachi, Kiyotaka*

doi: 10.1097/MAT.0000000000000857
Adult Circulatory Support

Our new Virtual Mock Loop (VML) is a mathematical model designed to simulate the human cardiovascular system and gauge performance of mechanical circulatory support devices. We aimed to mimic the hemodynamic performance of Cleveland Clinic’s self-regulating continuous-flow total artificial heart (CFTAH) via VML and evaluate VML’s accuracy versus bench data from our standard mock circulatory loop. The VML reproduced 23 hemodynamic conditions. Systemic/pulmonary vascular resistances and pump rotational speed were set for VML from bench test data. We compared outputs (pump flow, left/right pump pressure rise, normalized pump performance, and atrial pressure difference) of the two methods. Data from pump flow and left pump pressure rise were similar, but right pump pressure rise slightly differed. Left pump normalized pump performance curves were similar. Right pump VML results were within the same performance range indicated by bench tests. The plots of atrial pressure differences of VML versus bench-test data were similar, but slightly differed in the midrange of systemic/pulmonary gradients. Virtual Mock Loop successfully reproduced results from our mock circulatory loop of CFTAH test conditions. The CFTAH’s self-regulation feature of right pump performance was also calculated effectively. We foresee using versions of the VML for training, simulating physiologic cardiac conditions, and patient monitoring.

From the *Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio

R1 Engineering, Euclid, Ohio

Medical Device Solutions (Electronics Core), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.

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Submitted for consideration January 2018; accepted for publication in revised form June 2018.

D.J.H. and B.D.K. are coinventors of Cleveland Clinic’s continuous-flow total artificial heart (CFTAH), for which the Virtual Mock Loop was designed as a mathematical model. The CFTAH technology was licensed to Cleveland Heart, Inc., a Cleveland Clinic spinoff company. The remaining authors declare that they have no conflict of interest.

Software was funded and developed by R1 Engineering, LLC, Euclid, Ohio. The continuous-flow total artificial heart (CFTAH) program is supported with federal funding obtained from the National Heart, Lung and Blood Institute, National Institutes of Health, under grant R01HL096619 (to K.F.).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

D.J.H., formerly a member of the Department of Biomedical Engineering, is retired but remains a consultant to our group.

Correspondence: Kiyotaka Fukamachi, Department of Biomedical Engineering/ND20, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs