Continuous aortic flow augmentation: a pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure.
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.
Konstam
Marvin A
MA
Tufts-New England Medical Center, Tufts University, Boston, MA, USA. MKonstam@tufts-nemc.org
Czerska
Barbara
B
Böhm
Michael
M
Oren
Ron M
RM
Sadowski
Jerzy
J
Khanal
Sanjaya
S
Abraham
William T
WT
Wasler
Andrae
A
Dahm
Johannes B
JB
Gavazzi
Antonello
A
Gradinac
Sinisa
S
Legrand
Victor
V
Mohacsi
Paul
P
Poelzl
Gerhard
G
Radovancevic
Branislav
B
Van Bakel
Adrian B
AB
Zile
Michael R
MR
Cabuay
Barry
B
Bartus
Krzysztof
K
Jansen
Piet
P
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