A novel mechanical circulatory approach for patients with cardiogenic shock in the intensive care unit.
BACKGROUND
The capacity of the heart to maintain cardiac output can be acutely impaired as a result of myocardial infarction, graft failure after transplantation, or other cardiac events. Medical therapy or the use of an intra-aortic balloon pump may be insufficient to help the patient overcome acute cardiogenic shock. The set-up of mechanical assist devices such as extracorporeal membrane oxygenation or patient relocation into the operating room requires valuable time that is often not available. The aim of our study was to test whether a novel left ventricular assist device can be percutaneously implanted without fluoroscopy under echocardiographic navigation in a preclinical model.


METHODS
Pigs were subjected to percutaneous implantation of a novel left ventricular assist device under navigation of transesophageal echocardiography (TEE) without fluoroscopic support. Percutaneous puncture of the interatrial septum using a Brockenbrough needle and insertion of the afferent cannula into the femoral vein and its advance to the right atrium and through the interatrial septum into the left atrium was performed under echocardiographic control. The efferent cannula was inserted into the contralateral femoral artery using the Seldinger technique.


RESULTS
In all animals, the percutaneous implantation of a left ventricular assist device was successful under only TEE navigation.


CONCLUSIONS
The ability to abstain from fluoroscopy and the feasibility of inserting the afferent cannula across the interatrial septum guided by TEE allows for application of this system in intensive care units, saving precious time as well as financial and human resources.
Bara
Christoph
C
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
Ghodsizad
Alireza
A
Kar
Biswajit
B
Gregoric
Igor D
ID
Lichtenberg
Artur
A
Haverich
Axel
A
Karck
Matthias
M
Ruhparwar
Arjang
A
D000818:Animals; D001243:Assisted Circulation / Q000379:methods; D004195:Disease Models, Animal; D017548:Echocardiography, Transesophageal; D004638:Emergency Treatment; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D034421:Sus scrofa; D018084:Ultrasonography, Interventional