Predicted hemodynamic benefits of counterpulsation therapy using a superficial surgical approach.
A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0-50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure-volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients.
Giridharan
Guruprasad A
GA
Cardiovascular Innovation Institute, Departments of Surgery and Bioengineering, University of Louisville, 500 South Floyd Street, Louisville, KY 40202, USA.
Pantalos
George M
GM
Litwak
Kenneth N
KN
Spence
Paul A
PA
Koenig
Steven C
SC
D003198:Computer Simulation; D015908:Counterpulsation / Q000295:instrumentation* / Q000379:methods*; D003971:Diastole; D006333:Heart Failure / Q000628:therapy; D006439:Hemodynamics; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation; D008953:Models, Anatomic; D013318:Stroke Volume; D016277:Ventricular Function, Left