title: Miniature intracardiac assist device provides more effective cardiac unloading and circulatory support during severe left heart failure than intraaortic balloon pumping.
abstract: BACKGROUND
  Hemodynamic assistance with a miniature intracardiac pump may fill the treatment gap between use of an intraaortic balloon pump (IABP) and the current, more invasive ventricular assist devices. The objective of this study was to compare the hemodynamic efficacy of a miniature intracardiac pump device with that of IABP.
  
  
  RESULTS
  Reversible acute mitral regurgitation (AMR) was induced in eight calves by stenting the mitral valve using a vena cava filter. Full and partial AMR assist were compared with maximum IABP support in each animal. In full-support mode, both assist systems increased cardiac output (miniature intracardiac pump, 13% [p < 0.05]; IABP, 3% [p < 0.05]), mean aortic pressure (miniature intracardiac pump, 13% [p < 0.05]; IABP, 8% [p < 0.05]), carotid artery flow (miniature intracardiac pump, 29% [p < 0.05]; IABP, 5% [difference not significant]), and coronary blood flow (miniature intracardiac pump, 25% [difference not significant]; IABP, 34% [p < 0.05]). Again in full-support mode, both systems reduced left atrial pressure (miniature intracardiac pump, 2.4 mm Hg [p < 0.05]; IABP, 0.7 mm Hg [p < 0.05]), peak left ventricular (LV) pressure (miniature intracardiac pump, 13% [p < 0.05]; IABP, 5% [p < 0.05]), and external LV work (miniature intracardiac pump, 29% [p < 0.05]; IABP, 3% [p < 0.05]). Only full miniature intracardiac pump support reduced both end-diastolic LV volume (7%; p < 0.05) and end-systolic LV volume (10%; p < 0.05). IABP mainly improved coronary perfusion, while the miniature intracardiac pump proved more capable of genuinely unloading the LV.
  
  
  CONCLUSIONS
  We conclude that during severe acute LV failure, the miniature intracardiac pump is capable of more effective cardiac unloading and circulatory support than IABP.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Hospital Maastricht, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.
authors.forename: Koen D
authors.initials: KD
authors.lastname: Reesink
authors.forename: André L
authors.initials: AL
authors.lastname: Dekker
authors.forename: Vincent
authors.initials: V
authors.lastname: Van Ommen
authors.forename: Cecile
authors.initials: C
authors.lastname: Soemers
authors.forename: Gijs G
authors.initials: GG
authors.lastname: Geskes
authors.forename: Frederik H
authors.initials: FH
authors.lastname: van der Veen
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000208:Acute Disease; D000818:Animals; D002417:Cattle; D003326:Coronary Circulation / Q000502:physiology; D004195:Disease Models, Animal; D006353:Heart-Assist Devices; D006439:Hemodynamics; D007423:Intra-Aortic Balloon Pumping; D008904:Miniaturization / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology; D011474:Prosthesis Design; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology