Mechanical circulatory support devices improve tissue perfusion in patients with end-stage heart failure or cardiogenic shock.
OBJECTIVE
This study evaluated the effects of mechanical circulatory support (MCS) on sub-lingual microcirculation as a surrogate for splanchnic microvascular perfusion.


METHODS
Between May 2008 and April 2009, 10 consecutive patients received an MCS device or extracorporeal membrane oxygenation for end-stage chronic heart failure (n = 6) or cardiogenic shock (n = 4). Microcirculation was investigated using a hand-held Sidestream Dark Field imaging device. Perfused capillary density (PCD) and capillary red blood cell velocity (cRBCv) were assessed before device implantation (T0), immediately after implantation (T1), and 1 day after implantation (T2).


RESULTS
Median patient age was 45 years (interquartile range [IQR] 38-52 years) and 70% were men. MCS significantly decreased pulmonary capillary wedge pressure (p = 0.04). Median cardiac power index increased (0.29 [IQR, 0.21-0.34] W/m(2) at T0 vs 0.48 [IQR, 0.39-0.54] W/m(2) at T1, p = 0.005) as well as median central venous oxygen saturation (54% [IQR, 46%-61%] at T0 vs 78% [IQR, 67%-85%] at T1, p = 0.007). There was a 3-fold increase in tissue perfusion index (sub-lingual PCD x cRBCv) during mechanical circulatory support (573 [IQR, 407-693] at T0 vs 1909 [IQR, 1771-2835] at T1, p = 0.005). Microcirculatory parameters remained improved at T2.


CONCLUSIONS
Mechanical circulatory support for severe heart failure is associated with a consistent, significant, and sustained improvement in tissue perfusion, as measured at the bedside by a 2-dimensional microcirculation imaging technique.
den Uil
Corstiaan A
CA
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. c.denuil@erasmusmc.nl
Maat
Alexander P
AP
Lagrand
Wim K
WK
van der Ent
Martin
M
Jewbali
Lucia S D
LS
van Thiel
Robert J
RJ
Spronk
Peter E
PE
Simoons
Maarten L
ML
D000328:Adult; D001794:Blood Pressure; D006328:Cardiac Catheterization; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006339:Heart Rate; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000601:surgery*; D014059:Tongue / Q000098:blood supply