Comparison of myocardial loading between asynchronous pulsatile and nonpulsatile percutaneous extracorporeal life support.
We hypothesized that myocardial loading can be increased when extracorporeal pulse flow occurs during systole, and that this may adversely affect myocardial working conditions in heart failure patients supported by extracorporeal life support (ECLS). This study was designed to compare myocardial loading and myocardial oxygen consumption/supply balance between nonpulsatile ECLS and asynchronized pulsatile ECLS in a myocardial stunning model. Thirteen, 23-42 kg dogs were allotted to a nonpulsatile group and an asynchronous pulsatile group. Coronary sinus lactate level, mixed venous oxygen consumption (MvO2), and left anterior descending coronary artery flow were measured. The real-time pressure of the left ventricle and the ascending aorta was monitored, and the lowest left ventricular pressure and tension time index were calculated. Our results showed that the lactate level and the lowest left ventricular pressure were lower in the pulsatile group than in the nonpulsatile group at 30 minutes after ECLS was applicated (p < 0.05, respectively). Tension time index in the pulsatile ECLS group was substantially lower than in the nonpulsatile group. Left anterior descending coronary flow did not show significant difference between the two groups. In conclusion, asynchronous pulsatile ECLS may also be superior to nonpulsatile ECLS in myocardial volume unloading and oxygen consumption/supply balance.
Yu
Jeong Jin
JJ
Department of Pediatrics, School of Medicine, Konkuk University, Seoul, Korea.
Son
Ho Sung
HS
Lim
Choon Hak
CH
Lee
Jung Joo
JJ
Park
Young Woo
YW
Her
Keun
K
Won
Yong Soon
YS
Sun
Kyung
K
Choi
Jung Yun
JY
D000818:Animals; D001775:Blood Circulation / Q000502:physiology*; D004285:Dogs; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006321:Heart / Q000502:physiology*; D017682:Myocardial Stunning / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption / Q000502:physiology; D010107:Oxygenators, Membrane; D011673:Pulsatile Flow / Q000502:physiology*