title: Left ventricular mechanical support with Impella provides more ventricular unloading in heart failure than extracorporeal membrane oxygenation.
abstract: The Impella microaxial-flow pump can directly unload left ventricle (LV) in cases of acute heart failure. Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support. Although the clinical effectiveness of ECMO has been demonstrated, insufficient LV loading reduction may not be advantageous for myocardial recovery. The objective was to compare ventricular loading reduction and reversibility of ventricular fibrillation (VF) with either Impella or ECMO. Six dogs were used. Extracorporeal membrane oxygenation was established by the femoral artery and right atrium. The Impella LD was inserted in LV by the ascending aorta. An acute failing heart was created by sequential coronary artery ligations. Pressure-volume (PV) relationships were acquired without a device and with ECMO or Impella. When VF occurred, direct cardioversion was performed while supported by either ECMO or Impella. The PV area, which is a measure of ventricular unloading and is correlated with myocardial oxygen consumption, decreased more with Impella than with ECMO. Successful defibrillation was achieved more effectively while under Impella support. Superior ventricular unloading with the Impella device may provide higher recovery potential to damaged hearts than ECMO and may have a significant impact not only on intensive care of patients with heart failure but also on resuscitation.
authors.affiliation: Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Kawashima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gojo
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Yoshihumi
authors.initials: Y
authors.lastname: Itoda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitahori
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Morota
authors.forename: Arata
authors.initials: A
authors.lastname: Murakami
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000818:Animals; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000379:methods; D004195:Disease Models, Animal; D004285:Dogs; D004562:Electrocardiography; D015199:Extracorporeal Membrane Oxygenation; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006352:Heart Ventricles / Q000473:pathology; D006353:Heart-Assist Devices; D006439:Hemodynamics; D008297:Male; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy