title: Continuous aortic flow augmentation: a pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure.
abstract: BACKGROUND
  Diminished aortic flow may induce adverse downstream vascular and renal signals. Investigations in a heart failure animal model have shown that continuous aortic flow augmentation (CAFA) achieves hemodynamic improvement and ventricular unloading, which suggests a novel therapeutic approach to patients with heart failure exacerbation that is inadequately responsive to medical therapy.
  
  
  RESULTS
  We studied 24 patients (12 in Europe and 12 in the United States) with heart failure exacerbation and persistent hemodynamic derangement despite intravenous diuretic and inotropic and/or vasodilator treatment. CAFA (mean+/-SD 1.34+/-0.12 L/min) was achieved through percutaneous (n=19) or surgical (n=5) insertion of the Cancion system, which consists of inflow and outflow cannulas and a magnetically levitated and driven centrifugal pump. Hemodynamic improvement was observed within 1 hour. Systemic vascular resistance decreased from 1413+/-453 to 1136+/-381 dyne.s.cm(-5) at 72 hours (P=0.0008). Pulmonary capillary wedge pressure decreased from 28.5+/-4.9 to 19.8+/-7.0 mm Hg (P<0.0001), and cardiac index (excluding augmented aortic flow) increased from 1.97+/-0.44 to 2.27+/-0.43 L.min(-1).m(-2) (P=0.0013). Serum creatinine trended downward during treatment (overall P=0.095). There were 8 complications during treatment, 7 of which were self-limited. Hemodynamics remained improved 24 hours after CAFA discontinuation.
  
  
  CONCLUSIONS
  In patients with heart failure and persistent hemodynamic derangement despite intravenous inotropic and/or vasodilator therapy, CAFA improved hemodynamics, with a reduction in serum creatinine. CAFA represents a promising, novel mode of treatment for patients who are inadequately responsive to medical therapy. The clinical impact of the observed hemodynamic improvement is currently being explored in a prospective, randomized, controlled trial.
authors.affiliation: Tufts-New England Medical Center, Tufts University, Boston, MA, USA. MKonstam@tufts-nemc.org
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: Barbara
authors.initials: B
authors.lastname: Czerska
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Ron M
authors.initials: RM
authors.lastname: Oren
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Khanal
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Andrae
authors.initials: A
authors.lastname: Wasler
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Dahm
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Sinisa
authors.initials: S
authors.lastname: Gradinac
authors.forename: Victor
authors.initials: V
authors.lastname: Legrand
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.forename: Gerhard
authors.initials: G
authors.lastname: Poelzl
authors.forename: Branislav
authors.initials: B
authors.lastname: Radovancevic
authors.forename: Adrian B
authors.initials: AB
authors.lastname: Van Bakel
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Barry
authors.initials: B
authors.lastname: Cabuay
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bartus
authors.forename: Piet
authors.initials: P
authors.lastname: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D001783:Blood Flow Velocity; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007297:Inpatients; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000503:physiopathology*; D010865:Pilot Projects; D015995:Prevalence; D014481:United States / Q000453:epidemiology