title: Comparative Hemodynamic Effects of Contemporary Percutaneous Mechanical Circulatory Support Devices in a Porcine Model of Acute Myocardial Infarction.
abstract: The aim of this study was to directly compare the hemodynamic effects of 2 contemporary percutaneous mechanical circulatory support devices in a porcine model of acute myocardial infarction.
  
  
  
  Percutaneous support devices offer the ability to unload the ischemic left ventricle, but the comparative hemodynamic effects of contemporary platforms are unclear.
  
  
  
  Yorkshire swine (mean weight 76 ± 2 kg; n = 7) were instrumented with a left ventricular (LV) pressure-volume (PV) catheter and subjected to a 2-h coronary occlusion. Hemodynamic parameters and PV-derived indexes of LV performance were assessed 30 min after reperfusion and during LV support with Impella CP (ICP) and TandemHeart devices (in randomized order) at comparable flow rates.
  
  
  
  Myocardial infarction produced a rightward shift of the PV loop and increased LV end-diastolic pressure (from 9 ± 2 mm Hg to 15 ± 2 mm Hg; p = 0.04). After reperfusion, both devices maintained aortic pressure, shifted the PV loop to the left, and decreased LV end-diastolic pressure (ICP vs. TandemHeart; 11 ± 1 mm Hg vs. 7 ± 4 mm Hg; p = 0.04). However, only TandemHeart elicited significant reductions in native LV stroke volume (from 75 ± 7 ml to 39 ± 7 ml; p < 0.01), dP/dtmax(from 988 ± 77 mm Hg/s to 626 ± 42 mm Hg/s; p < 0.01), stroke work (from 0.70 ± 0.03 J to 0.26 ± 0.05 J; p < 0.01), PV area (from 0.95 ± 0.11 J to 0.47 ± 0.10 J; p < 0.01), and pre-load-recruitable stroke work slope (from 41.7 ± 2.8 J/ml to 30.6 ± 3.9 J/ml; p = 0.05).
  
  
  
  At comparable device flow rates, TandemHeart decreased LV pre-load, native LV stroke volume, and myocardial contractility to a greater degree than ICP. Reductions in load-independent indexes of LV performance indicate favorable effects on myocardial oxygen balance and support further study of TandemHeart in clinical scenarios requiring mechanical support in the setting of acute myocardial ischemia.
authors.affiliation: Department of Physiology and Biophysics, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York. Electronic address: bweil@buffalo.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Weil
authors.affiliation: Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Filip
authors.initials: F
authors.lastname: Konecny
authors.affiliation: Department of Medicine, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York.
authors.forename: Gen
authors.initials: G
authors.lastname: Suzuki
authors.affiliation: Department of Medicine, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York.
authors.forename: Vijay
authors.initials: V
authors.lastname: Iyer
authors.affiliation: Department of Physiology and Biophysics, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York; Department of Medicine, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York; Department of Biomedical Engineering, The Clinical and Translational Research Center of the University at Buffalo, Buffalo, New York; VA Western New York Healthcare System, Buffalo, New York.
authors.forename: John M
authors.initials: JM
authors.lastname: Canty
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization; D004195:Disease Models, Animal; D006353:Heart-Assist Devices; D006439:Hemodynamics; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D020127:Recovery of Function; D013318:Stroke Volume; D034421:Sus scrofa; D013997:Time Factors; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
keywords: acute myocardial infarction; left ventricular assist device; percutaneous mechanical circulatory support; ventricular unloading