Transvalvular left ventricular assistance in acute myocardial infarction with cardiogenic shock and high risk angioplasty: experimental and clinical results with the Hemopump.
The Hemopump has been shown to be an effective left ventricular assist device. It is capable of supporting the circulation in patients with profound left ventricular dysfunction in the setting of cardiogenic shock. In experimental animals it seems possible that supporting the circulation immediately prior to reperfusion will produce a significant decrease in infarct size, which has important clinical ramifications, particularly in the setting of patients with large anterior myocardial infarction. The mechanism for this infarct salvage is unclear at the present time and requires further investigation, at a more basic level. The current tools available to the cardiologist include the intraaortic balloon pump and the cardiopulmonary support system (CPS), (PCs, BARD, Inc.). The Hemopump is available in Europe, but not in the United States at the present time. Clearly, the CPS system is the most powerful of the devices available, producing up to 61/m of flow. Unfortunately, there are a number of drawbacks with the CPS system, including its need for an oxygenator, which limits its useful period of support to approximately 8 hours. Additionally, support with the PCS system may be associated with adverse physiological events. The intraaortic balloon pump requires synchronization with the cardiac cycle, and hence, is not suitable for patients with significant tachyarrhythmias. Patients with overt cardiac arrest, similarly, cannot be supported with the intraaortic balloon pump. Nonetheless, the balloon pump has been associated with improved infarct salvage in an experimental animal model. On the other hand, the Hemopump, in its first version, required a surgical incision and placement of a graft onto the femoral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Smalling
R W
RW
Division of Cardiology, University of Texas Medical School, Houston 77030, USA.
D015906:Angioplasty, Balloon, Coronary; D000818:Animals; D006353:Heart-Assist Devices; D006464:Hemoperfusion; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D012770:Shock, Cardiogenic; D016019:Survival Analysis