Comparative Hemodynamic Effects of Contemporary Percutaneous Mechanical Circulatory Support Devices in a Porcine Model of Acute Myocardial Infarction

Brian R Weil; Filip Konecny; Gen Suzuki; Vijay Iyer; John M Canty Jr

doi:10.1016/j.jcin.2016.08.037

Comparative Hemodynamic Effects of Contemporary Percutaneous Mechanical Circulatory Support Devices in a Porcine Model of Acute Myocardial Infarction

JACC Cardiovasc Interv. 2016 Nov 28;9(22):2292-2303. doi: 10.1016/j.jcin.2016.08.037. Epub 2016 Oct 26.

Authors

Brian R Weil¹, Filip Konecny², Gen Suzuki³, Vijay Iyer³, John M Canty Jr⁴

Affiliations

¹ Department of Physiology and Biophysics, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York. Electronic address: bweil@buffalo.edu.
² Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
³ Department of Medicine, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York.
⁴ Department of Physiology and Biophysics, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York; Department of Medicine, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York; Department of Biomedical Engineering, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York; VA Western New York Healthcare System, Buffalo, New York.

Abstract

Objectives: The aim of this study was to directly compare the hemodynamic effects of 2 contemporary percutaneous mechanical circulatory support devices in a porcine model of acute myocardial infarction.

Background: Percutaneous support devices offer the ability to unload the ischemic left ventricle, but the comparative hemodynamic effects of contemporary platforms are unclear.

Methods: Yorkshire swine (mean weight 76 ± 2 kg; n = 7) were instrumented with a left ventricular (LV) pressure-volume (PV) catheter and subjected to a 2-h coronary occlusion. Hemodynamic parameters and PV-derived indexes of LV performance were assessed 30 min after reperfusion and during LV support with Impella CP (ICP) and TandemHeart devices (in randomized order) at comparable flow rates.

Results: Myocardial infarction produced a rightward shift of the PV loop and increased LV end-diastolic pressure (from 9 ± 2 mm Hg to 15 ± 2 mm Hg; p = 0.04). After reperfusion, both devices maintained aortic pressure, shifted the PV loop to the left, and decreased LV end-diastolic pressure (ICP vs. TandemHeart; 11 ± 1 mm Hg vs. 7 ± 4 mm Hg; p = 0.04). However, only TandemHeart elicited significant reductions in native LV stroke volume (from 75 ± 7 ml to 39 ± 7 ml; p < 0.01), dP/dt_max (from 988 ± 77 mm Hg/s to 626 ± 42 mm Hg/s; p < 0.01), stroke work (from 0.70 ± 0.03 J to 0.26 ± 0.05 J; p < 0.01), PV area (from 0.95 ± 0.11 J to 0.47 ± 0.10 J; p < 0.01), and pre-load-recruitable stroke work slope (from 41.7 ± 2.8 J/ml to 30.6 ± 3.9 J/ml; p = 0.05).

Conclusions: At comparable device flow rates, TandemHeart decreased LV pre-load, native LV stroke volume, and myocardial contractility to a greater degree than ICP. Reductions in load-independent indexes of LV performance indicate favorable effects on myocardial oxygen balance and support further study of TandemHeart in clinical scenarios requiring mechanical support in the setting of acute myocardial ischemia.

Keywords: acute myocardial infarction; left ventricular assist device; percutaneous mechanical circulatory support; ventricular unloading.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Animals
Cardiac Catheterization
Disease Models, Animal
Heart-Assist Devices*
Hemodynamics*
Myocardial Infarction / diagnosis
Myocardial Infarction / physiopathology
Myocardial Infarction / therapy*
Prosthesis Design
Recovery of Function
Stroke Volume
Sus scrofa
Time Factors
Ventricular Function, Left*
Ventricular Pressure

Abstract

Publication types

MeSH terms

Grants and funding