1
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Lamberti KK, Goffer EM, Edelman ER, Keller SP. Differential Effects of Pharmacologic and Mechanical Support on Right-Left Ventricular Coupling. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10522-w. [PMID: 38767797 DOI: 10.1007/s12265-024-10522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Percutaneous ventricular assist devices are increasingly relied on to maintain perfusion for cardiogenic shock patients. Optimal medical management strategies however remain uncertain from limited understanding of interventricular effects. This study analyzed the effects of pharmacologic and left-sided mechanical support on right ventricular function. METHODS A porcine model was developed to assess biventricular function during bolus pharmacologic administration before and after left-sided percutaneous ventricular assist and in cardiogenic shock. RESULTS The presence of mechanical support increased right ventricular load and stress with respect to the left ventricle. This shifted and exaggerated the relative effects of commonly used vasoactive agents. Furthermore, induction of cardiogenic shock led to differential pulmonary vascular and right ventricular responses. CONCLUSIONS Left ventricular ischemia and mechanical support altered interventricular coupling. Resulting impacts of pharmacologic agents indicate differential right heart responses and sensitivity to treatments and the need for further study to optimize biventricular function in shock patients.
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Affiliation(s)
- Kimberly K Lamberti
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Efrat M Goffer
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Medicine (Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven P Keller
- Department of Medicine (Pulmonary and Critical Care Medicine), Johns Hopkins University, 1830 E. Monument Street 1830 Building; 5th Floor, Baltimore, MD, 21215, USA.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21215, USA.
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2
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Rivero F, Roquero P, Cuesta J, Bastante T, Del Val D, Aguilar R, Salamanca J, Díez-Villanueva P, Alfonso F. Improvement in the Infarct-Related Artery Coronary Flow by Impella Support. JACC Cardiovasc Interv 2023; 16:2191-2193. [PMID: 37565967 DOI: 10.1016/j.jcin.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 08/12/2023]
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3
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Hisham M, Ghalib HH, Kakar V, Kumar GP, Bader F, Atallah B. Anticoagulation practices and complications associated with Impella® support at an advanced cardiac center in the Middle East gulf region. J Thromb Thrombolysis 2023:10.1007/s11239-023-02807-9. [PMID: 37097552 DOI: 10.1007/s11239-023-02807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
Anticoagulation during Impella® support is a challenge due to its complications and inconsistent practice across the globe. This observational, retrospective chart review included all patients with Impella® support at our advanced cardiac center at a quaternary care hospital in the Middle East gulf region. The study was conducted over six years (2016-2022), a time period during which manufacturer recommendations for purge solution, anticoagulation protocols as well as Impella® place in therapy and utilization were all evolving. We aimed to evaluate the efficacy of different anticoagulation practices and association with complications and outcomes. Forty-one patients underwent Impella® during the study period, including 25 patients with support for more than 12 h, and are the focus of our analysis. Cardiogenic shock (n = 25, 60.9%) was the primary indication for Impella®, followed by facilitating high-risk PCI (n = 15, 36.7%) and left ventricular afterload reduction in patients undergoing veno-arterial extracorporeal membrane oxygenation (n = 1, 2.4%). Our overall Impella® usage evolved over the years from a primary use to facilitate a high-risk PCI to the recent more common use of LV unloading in cardiogenic shock. No patients experienced device malfunction and the incidence of other complications including ischemic stroke and bleeding were comparable to those reported in the literature (12.2% and 24% respectively). The 30-day all-cause mortality of 41 patients was 53.6%. In line with the evolving recommendations and evidence, we observed an underutilization of non-heparin-based purge solutions and inconsistent management of anticoagulation in the setting of both Impella® and VA ECMO which necessitates more education and protocols.
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Affiliation(s)
- Mohamed Hisham
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Hussam H Ghalib
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
| | - Vivek Kakar
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
| | - G Praveen Kumar
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
| | - Feras Bader
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
| | - Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE.
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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4
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Hussey PT, von Mering G, Nanda NC, Ahmed MI, Addis DR. Echocardiography for extracorporeal membrane oxygenation. Echocardiography 2022; 39:339-370. [PMID: 34997645 PMCID: PMC9195253 DOI: 10.1111/echo.15266] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/16/2021] [Accepted: 11/06/2021] [Indexed: 02/03/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary life support for patients in cardiac and/or respiratory failure. Echocardiography provides essential diagnostic and anatomic information prior to ECMO initiation, allows for safe and efficient ECMO cannula positioning, guides optimization of flow, provides a modality for rapid troubleshooting and patient evaluation, and facilitates decision-making for eventual weaning of ECMO support. Currently, guidelines for echocardiographic assessment in this clinical context are lacking. In this review, we provide an overview of echocardiographic considerations for advanced imagers involved in the care of these complex patients. We focus predominately on new cannulas and complex cannulation techniques, including a special focus on double lumen cannulas and a section discussing indirect left ventricular venting. Echocardiography is tremendously valuable in providing optimal care in these challenging clinical situations. It is imperative for imaging physicians to understand the pertinent anatomic considerations, the often complicated physiological and hemodynamic context, and the limitations of the imaging modality.
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Affiliation(s)
- Patrick T. Hussey
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Gregory von Mering
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Navin C. Nanda
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Mustafa I. Ahmed
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Dylan R. Addis
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Division of Molecular and Translational Biomedicine, and the UAB Comprehensive Cardiovascular Center, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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5
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Weisskopf M, Kron M, Giering T, Walker T, Cesarovic N. The sheep as a pre-clinical model for testing intra-aortic percutaneous mechanical circulatory support devices. Int J Artif Organs 2021; 44:703-710. [PMID: 34405723 PMCID: PMC8450982 DOI: 10.1177/03913988211025537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The save deployment of intra-aortic percutaneous mechanical circulatory support devices is highly dependent on the inner aortic diameter. Finding the anatomically and ethically most suitable animal model for performance testing of new pMCS devices remains challenging. For this study, an ovine model using adult ewes of a large framed breed (Swiss White Alpine Sheep) was developed to test safety, reliability, and biocompatibility of catheter-mounted mechanical support devices placed in the descending thoracic aorta. Following the drawback of fluctuating aortic diameter and device malfunction in the first four animals, the model was improved by stenting the following animals with an aortic stent. Stenting the animals with an intra-aortic over the balloon stent was found to standardize the experimental set-up and to avoid early termination of the experiment due to non-device related issues.
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Affiliation(s)
- Miriam Weisskopf
- Center of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mareike Kron
- Center of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Nikola Cesarovic
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
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6
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Hugenroth K, Neidlin M, Engelmann UM, Kaufmann TAS, Steinseifer U, Heilmann T. Tipless transseptal cannula concept combines improved hemodynamic properties and risk-reduced placement: An in silico proof-of-concept. Artif Organs 2021; 45:1024-1035. [PMID: 33851427 DOI: 10.1111/aor.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
As a leading cause of death worldwide, heart failure is a serious medical condition in which many critically ill patients require temporary mechanical circulatory support (MCS) as a bridge-to-recovery or bridge-to-decision. In many cases, the TandemHeart system is used to unload the left heart by draining blood from the left atrium (LA) to the femoral artery via a transseptal multistage cannula. However, even though the correct positioning of the cannula is crucial for a safe treatment, the long cannula tip currently used in transseptal cannulas complicates positioning, making the cannula vulnerable to displacement during MCS. To overcome these limitations, we propose the development of a new tipless transseptal cannula with improved hemodynamic properties. We discuss the tipless cannula concept by comparing it to the common multistage cannula concept using computational fluid dynamics simulations and assess the flow field in the LA, the wall shear stresses (WSS), and the pressure loss. Across the two distinct time points of end-systole and end-diastole and two drainage flow rates of 3.5 and 5.0 L/min, we find a more homogeneous inlet flow pattern for the tipless cannula concept, accompanied by a remarkably reduced area of platelet-activating WSS (up to 10-times smaller area compared to the multistage cannula). Moreover, pressure loss is up to 14.5% lower in the tipless cannula concept, confirming overall improved hemodynamic properties of the tipless cannula concept. Finally, a diameter-dependent study reveals that lower WSS and pressure losses can be further reduced by large-lumen designs for any simulation setting. Overall, our results suggest that a tipless cannula concept remedies the crucial disadvantages of a long-tip multistage cannula by reducing the risk of misplacement, and it furthermore promotes optimized hemodynamics. With this successful proof-of-concept, we underscore the potential for and encourage the realization of further experimental investigations regarding the development of a tipless transseptal cannula for MCS.
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Affiliation(s)
- Kristin Hugenroth
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,enmodes GmbH, Aachen, Germany
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Ulrich M Engelmann
- enmodes GmbH, Aachen, Germany.,Department of Medical Engineering and Applied Mathematics, FH Aachen University of Applied Sciences, Aachen, Germany
| | - Tim A S Kaufmann
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,enmodes GmbH, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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7
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Abstract
The main reason for the emergency implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is the restoration of adequate systemic perfusion, while protecting the failing heart and promoting myocardial recovery are equally important goals. Following initial haemodynamic stabilization and often the urgent revascularization of the culprit lesion, the clinical focus is then directed towards the most efficient strategy for cardioprotection. Frequent echocardiography measurements may help to estimate the degree of unwanted left ventricular (LV) overloading during VA-ECMO. Additionally, the estimation of high LV filling pressures by Doppler echocardiography or their (in-)direct measurement using a dedicated surgical left atrial pressure line and conventional pulmonary artery catheter in a wedge position or a pigtail catheter in the left ventricle can be performed. Mechanical overload of the left ventricle is the major adverse effect and an obvious mechanistic and prognostic challenge of contemporary ECMO care. Many efforts are under way to overcome this phenomenon by LV unloading, which was effectively achieved by the current combined approach using an axial decompression device, while novel technical developments and approaches are tested and urgently anticipated. The aim of this report is to introduce in depth pathophysiological background, current concepts, and future perspectives in LV unloading strategies.
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Affiliation(s)
- Jan Belohlavek
- Complex Cardiovascular Center, 2nd Department of Internal Medicine, Cardiovascular Medicine, General University Hospital and 1st School of Medicine, Charles University of Prague, 12800 Prague, Czech Republic
| | - Patrick Hunziker
- Intensive Care Unit, University Hospital Basel, Petersgraben 5, 4031, Basel, Switzerland
| | - Dirk W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Cardiovascular and Respiratory Physiology Group, TechMed Center, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
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8
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van Dort DI, Thannhauser J, Morshuis WJ, Geuzebroek GS, Duncker DJ. A novel intra-ventricular assist device enhances cardiac performance in normal and acutely failing isolated porcine hearts. Int J Artif Organs 2021; 45:388-396. [PMID: 33818165 PMCID: PMC8921884 DOI: 10.1177/03913988211003912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: We recently demonstrated that a novel intra-ventricular membrane pump (IVMP) was able to increase the pump function of isolated beating porcine hearts. In follow-up, we now investigated the impact of the IVMP on myocardial oxygen consumption and total mechanical efficiency (TME) and assessed the effect of IVMP-support in acutely failing hearts. Methods: In 10 ex vivo beating porcine hearts, we studied hemodynamic parameters, as well as arterial and coronary venous oxygen content. We assessed cardiac power (CP), myocardial oxygen consumption (MVO2), and TME (CP divided by MVO2) under baseline conditions and during IVMP-support. Additionally, five isolated hearts were subjected to global hypoxia to investigate the effects of IVMP-support on CP under conditions of acute heart failure. Results: Under physiological conditions, baseline CP was 0.36 ± 0.10 W, which increased to 0.65 ± 0.16 W during IVMP-support (increase of 85% ± 24, p < 0.001). This was accompanied by an increase in MVO2 from 18.6 ± 6.2 ml/min at baseline, to 22.3 ± 5.0 ml/min during IVMP-support (+26 ± 31%, p = 0.005). As a result, TME (%) increased from 5.9 ± 1.2 to 8.8 ± 1.8 (50 ± 22% increase, p < 0.001). Acute hypoxia-induced cardiac pump failure reduced CP by 35 ± 6%, which was fully restored to baseline levels during IVMP-support in all hearts. Conclusion: IVMP-support improved mechanical efficiency under physiological conditions, as the marked increase in cardiac performance only resulted in a modest increase in oxygen consumption. Moreover, the IVMP rapidly restored cardiac performance under conditions of acute pump failure. These observations warrant further study, to evaluate the effects of IVMP-support in in vivo animal models of acute cardiac pump failure.
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Affiliation(s)
- Daniël Im van Dort
- Department of Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Jos Thannhauser
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | - Dirk J Duncker
- Department of Experimental Cardiology, Erasmus MC, Rotterdam, The Netherlands
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9
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Meani P, Mlcek M, Kowalewski M, Raffa GM, Popkova M, Pilato M, Arcadipane A, Belohlavek J, Lorusso R. Transaortic or Pulmonary Artery Drainage for Left Ventricular Unloading in Venoarterial Extracorporeal Life Support: A Porcine Cardiogenic Shock Model. Semin Thorac Cardiovasc Surg 2020; 33:724-732. [DOI: 10.1053/j.semtcvs.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022]
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10
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Silva KAS, Emter CA. Large Animal Models of Heart Failure: A Translational Bridge to Clinical Success. JACC Basic Transl Sci 2020; 5:840-856. [PMID: 32875172 PMCID: PMC7452204 DOI: 10.1016/j.jacbts.2020.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
Preclinical large animal models play a critical and expanding role in translating basic science findings to the development and clinical approval of novel cardiovascular therapeutics. This state-of-the-art review outlines existing methodologies and physiological phenotypes of several HF models developed in large animals. A comprehensive list of porcine, ovine, and canine models of disease are presented, and the translational importance of these studies to clinical success is highlighted through a brief overview of recent devices approved by the FDA alongside associated clinical trials and preclinical animal reports. Increasing the use of large animal models of HF holds significant potential for identifying new mechanisms underlying this disease and providing valuable information regarding the safety and efficacy of new therapies, thus, improving physiological and economical translation of animal research to the successful treatment of human HF.
Preclinical large animal models of heart failure (HF) play a critical and expanding role in translating basic science findings to the development and clinical approval of novel therapeutics and devices. The complex combination of cardiovascular events and risk factors leading to HF has proved challenging for the development of new treatments for these patients. This state-of-the-art review presents historical and recent studies in porcine, ovine, and canine models of HF and outlines existing methodologies and physiological phenotypes. The translational importance of large animal studies to clinical success is also highlighted with an overview of recent devices approved by the Food and Drug Administration, together with preclinical HF animal studies used to aid both development and safety and/or efficacy testing. Increasing the use of large animal models of HF holds significant potential for identifying the novel mechanisms underlying the clinical condition and to improving physiological and economical translation of animal research to successfully treat human HF.
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Key Words
- AF, atrial fibrillation
- ECM, extracellular matrix
- EDP, end-diastolic pressure
- EF, ejection fraction
- FDA, Food and Drug Administration
- HF, heart failure
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- HFrEF
- HFrEF, heart failure with reduced ejection fraction
- I/R, ischemia/reperfusion
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- LCx, left circumflex
- LV, left ventricular
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- RV, right ventricular
- heart failure
- large animal model
- preclinical
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Affiliation(s)
| | - Craig A Emter
- Department of Biomedical Sciences, University of Missouri-Columbia, Columbia, Missouri
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11
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A total closed chest sheep model of cardiogenic shock by percutaneous intracoronary ethanol injection. Sci Rep 2020; 10:12417. [PMID: 32709984 PMCID: PMC7381645 DOI: 10.1038/s41598-020-68571-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022] Open
Abstract
To develop a reproducible and stable closed chest model of ischemic cardiogenic shock in sheep, with high survival rate and potential insight into human pathology. We established a protocol for multi-step myocardial alcoholisation of the left anterior descending coronary artery by percutaneous ethanol injection. A thorough hemodynamic assessment was obtained by invasive and non-invasive monitoring devices. Repeated blood samples were obtained to determine haemoglobin and alcohol concentration, electrolytes, blood gas parameters and cardiac troponin I. After sacrifice, tissue was excised for quantification of infarction and histology. Cardiogenic shock was characterized by a significant decrease in mean arterial pressure (− 33%), cardiac output (− 29%), dP/dtmax (− 28%), carotid blood flow (− 22%), left ventricular fractional shortening (− 28%), and left ventricle end-systolic pressure–volume relationship (− 51%). Lactate and cardiac troponin I levels increased from 1.4 ± 0.2 to 4.9 ± 0.7 mmol/L (p = 0.001) and from 0.05 ± 0.02 to 14.74 ± 2.59 µg/L (p = 0.001), respectively. All haemodynamic changes were stable over a three-hour period with a 71% survival rate. The necrotic volume (n = 5) represented 24.0 ± 1.9% of total ventricular mass. No sham exhibited any variation under general anaesthesia. We described and characterized, for the first time, a stable, reproducible sheep model of cardiogenic shock obtained by percutaneous intracoronary ethanol administration.
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12
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Dort DIM, Thannhauser J, Gommans FDH, Ten Cate TJ, Duncker DJ, Suryapranata H, Morshuis WJ, Geuzebroek GSC. Proof of principle of a novel co‐pulsating intra‐ventricular membrane pump. Artif Organs 2020; 44:1267-1275. [DOI: 10.1111/aor.13757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Daniël I. M. Dort
- Department of Cardiothoracic Surgery Radboudumc Nijmegen The Netherlands
| | - Jos Thannhauser
- Department of Cardiology Radboudumc Nijmegen The Netherlands
| | | | - Tim J. Ten Cate
- Department of Cardiology Radboudumc Nijmegen The Netherlands
| | - Dirk J. Duncker
- Department of Experimental Cardiology Erasmus MC Rotterdam The Netherlands
| | | | - Wim J. Morshuis
- Department of Cardiothoracic Surgery Radboudumc Nijmegen The Netherlands
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13
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Alkhouli M. Left ventricular unloading in ST‐elevation myocardial infarction without cardiogenic shock. Artif Organs 2020; 44:773-778. [DOI: 10.1111/aor.13721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine Mayo Clinic School of Medicine Rochester MN USA
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14
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Mechanical circulatory support devices in cardiogenic shock and acute heart failure: current evidence. Curr Opin Crit Care 2020; 25:391-396. [PMID: 31135393 DOI: 10.1097/mcc.0000000000000629] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The main purpose of this review is to highlight and summarize recently published studies on the usage of short-term mechanical circulatory support devices for treatment of cardiogenic shock. Importantly, this review will focus on percutaneously implanted devices. RECENT FINDINGS In recent years, usage of active mechanical circulatory support devices, such as catheter-based left ventricular-assist devices and veno-arterial extracorporeal membrane oxygenation devices, has been widely adopted. Several device-specific strategies have been proposed to improve outcome of treated patients with cardiogenic shock, ranging from early identification and treatment of patients via dedicated shock protocols to combinatory usage of these devices. However, this is not supported by prospective, randomized trials but by retrospective analysis, which are significantly impacted by bias. SUMMARY Randomized, controlled trials are utterly needed to guide treatment with mechanical circulatory support for patients with cardiogenic shock. Importantly, such trials should focus patient selection criteria.
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15
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van Diepen S, Baran DA, Mebazaa A. What Is the Role of Medical Therapy in Cardiogenic Shock in the Era of Mechanical Circulatory Support? Can J Cardiol 2019; 36:151-153. [PMID: 31924451 DOI: 10.1016/j.cjca.2019.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada; Canadian Vigour Center, University of Alberta, Edmonton, Alberta, Canada.
| | - David A Baran
- Sentara Heart Hospital, Advanced Heart Failure Center, and Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Alexandre Mebazaa
- Université de Paris, U942 Inserm-MASCOT, Paris, France; APHP, Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires, Saint Louis Lariboisière, Paris, France
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16
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The cell biological basis for primary unloading in acute myocardial infarction. Int J Cardiol 2019; 293:45-47. [PMID: 31296394 DOI: 10.1016/j.ijcard.2019.06.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022]
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17
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Weil BR, Techiryan G, Suzuki G, Konecny F, Canty JM. Adaptive Reductions in Left Ventricular Diastolic Compliance Protect the Heart From Stretch-Induced Stunning. JACC Basic Transl Sci 2019; 4:527-541. [PMID: 31468008 PMCID: PMC6712414 DOI: 10.1016/j.jacbts.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/04/2022]
Abstract
Swine subjected to 2 weeks of repetitive pressure overload (RPO) exhibited significant myocyte loss, but left ventricular (LV) systolic function was preserved, and chamber dilatation did not occur. Instead, myocardial remodeling characterized by myocyte hypertrophy and interstitial fibrosis led to a marked reduction in LV diastolic compliance, which protected the heart from stretch-induced myocyte injury and preserved LV ejection fraction without anatomic LV hypertrophy. These results support a novel paradigm that links cardiac adaptations to RPO with the pathogenesis of reduced LV diastolic compliance and may explain how LV stiffening can occur in the absence of sustained hypertension or anatomic hypertrophy.
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Key Words
- BP, blood pressure
- EDPVR, end-diastolic pressure−volume relationship
- HFpEF, heart failure with preserved ejection fraction
- LV, left ventricular
- LVEDP, left ventricular end-diastolic pressure
- LVEDV, left ventricular end-diastolic volume
- PE, phenylephrine
- PV, pressure−volume
- RPO, repetitive pressure overload
- TUNEL, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling
- cTnI, cardiac troponin I
- diastolic dysfunction
- fibrosis
- heart failure
- myocardial stunning
- stretch
- ΔEDP/ΔEDV, changes in end-diastolic pressure/end-diastolic volume
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Affiliation(s)
- Brian R. Weil
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York
- The Clinical and Translational Research Center, University at Buffalo, Buffalo, New York
| | - George Techiryan
- The Clinical and Translational Research Center, University at Buffalo, Buffalo, New York
- Department of Medicine, University at Buffalo, Buffalo, New York
| | - Gen Suzuki
- The Clinical and Translational Research Center, University at Buffalo, Buffalo, New York
- Department of Medicine, University at Buffalo, Buffalo, New York
| | - Filip Konecny
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - John M. Canty
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York
- The Clinical and Translational Research Center, University at Buffalo, Buffalo, New York
- Department of Medicine, University at Buffalo, Buffalo, New York
- VA WNY Health Care System, Buffalo, New York
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York
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18
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Suzuki G, Weil BR, Young RF, Fallavollita JA, Canty JM. Nonocclusive multivessel intracoronary infusion of allogeneic cardiosphere-derived cells early after reperfusion prevents remote zone myocyte loss and improves global left ventricular function in swine with myocardial infarction. Am J Physiol Heart Circ Physiol 2019; 317:H345-H356. [PMID: 31125261 DOI: 10.1152/ajpheart.00124.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intracoronary cardiosphere-derived cells (icCDCs) infused into the infarct-related artery reduce scar volume but do not improve left ventricular (LV) ejection fraction (LVEF). We tested the hypothesis that this reflects the inability of regional delivery to prevent myocyte death or promote myocyte proliferation in viable myocardium remote from the infarct. Swine (n = 23) pretreated with oral cyclosporine (200 mg/day) underwent a 1-h left anterior descending coronary artery (LAD) occlusion, which reduced LVEF from 61.6 ± 1.0 to 45.3 ± 1.5% 30 min after reperfusion. At that time, animals received global infusion of allogeneic icCDCs (n = 8), regional infusion of icCDCs restricted to the LAD using the stop-flow technique (n = 8), or vehicle (n = 7). After 1 mo, global icCDCs increased LVEF from 44.8 ± 1.9 to 60.8 ± 3.8% (P < 0.05) with no significant change after LAD stop-flow icCDCs (44.8 ± 3.6 to 50.9 ± 3.1%) or vehicle (46.5 ± 2.5 to 47.7 ± 2.6%). In contrast, global icCDCs did not alter infarct volume (%LV mass) assessed at 2 days (11.2 ± 2.3 vs. 12.6 ± 2.3%), whereas it was reduced after LAD stop-flow icCDCs (7.1 ± 1.1%, P < 0.05). Histopathological analysis of remote myocardium after global icCDCs demonstrated a significant increase in myocyte proliferation (147 ± 32 vs. 14 ± 10 nuclei/106 myocytes, P < 0.05) and a reduction in myocyte apoptosis (15 ± 9 vs. 46 ± 10 nuclei/106 myocytes, P < 0.05) that increased myocyte nuclear density (1,264 ± 39 vs. 1,157 ± 33 nuclei/mm2, P < 0.05) and decreased myocyte diameter (13.2 ± 0.2 vs. 14.5 ± 0.3 μm, P < 0.05) compared with vehicle-treated controls. In contrast, remote zone changes after regional LAD icCDCs were no different from vehicle. These data indicate that changes in global LVEF after icCDCs are dependent upon preventing myocyte loss and hypertrophy in myocardium remote from the infarct. These arise from stimulating myocyte proliferation and reducing myocyte apoptosis indicating the importance of directing cell therapy to viable remote regions.NEW & NOTEWORTHY Administration of allogeneic cardiosphere-derived cells to the entire heart via global intracoronary infusion shortly after myocardial infarction favorably influenced left ventricular ejection fraction by preventing myocyte death and promoting myocyte proliferation in remote, noninfarcted myocardium in swine. In contrast, regional intracoronary cell infusion did not significantly affect remote zone myocyte remodeling. Global cell administration targeting viable myocardium remote from the infarct may be an effective approach to prevent adverse ventricular remodeling after myocardial infarction.
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Affiliation(s)
- Gen Suzuki
- Department of Medicine, University at Buffalo, Buffalo, New York.,Clinical and Translational Research Institute, University at Buffalo, Buffalo, New York
| | - Brian R Weil
- Physiology and Biophysics, University at Buffalo, Buffalo, New York.,Clinical and Translational Research Institute, University at Buffalo, Buffalo, New York
| | - Rebeccah F Young
- Department of Medicine, University at Buffalo, Buffalo, New York.,Clinical and Translational Research Institute, University at Buffalo, Buffalo, New York
| | - James A Fallavollita
- Veterans Affairs Western New York Health Care System, Buffalo, New York.,Department of Medicine, University at Buffalo, Buffalo, New York.,Clinical and Translational Research Institute, University at Buffalo, Buffalo, New York
| | - John M Canty
- Veterans Affairs Western New York Health Care System, Buffalo, New York.,Department of Medicine, University at Buffalo, Buffalo, New York.,Physiology and Biophysics, University at Buffalo, Buffalo, New York.,Biomedical Engineering, University at Buffalo, Buffalo, New York.,Clinical and Translational Research Institute, University at Buffalo, Buffalo, New York
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19
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Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F, Pieri M, Skurk C, Lauten A, Landmesser U, Westenfeld R, Horn P, Pauschinger M, Eckner D, Twerenbold R, Nordbeck P, Salinger T, Abel P, Empen K, Busch MC, Felix SB, Sieweke JT, Møller JE, Pareek N, Hill J, MacCarthy P, Bergmann MW, Henriques JP, Möbius-Winkler S, Schulze PC, Ouarrak T, Zeymer U, Schneider S, Blankenberg S, Thiele H, Schäfer A, Westermann D. Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock. Circulation 2019; 139:1249-1258. [DOI: 10.1161/circulationaha.118.036614] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Benedikt Schrage
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
| | - Karim Ibrahim
- University Heart Centre Dresden, Department of Cardiology and Intensive Care, Germany (K.I., T.L.)
| | - Tobias Loehn
- University Heart Centre Dresden, Department of Cardiology and Intensive Care, Germany (K.I., T.L.)
| | - Nikos Werner
- University Heart Centre Bonn, Department of Cardiology, Germany (N.W., J-M.S.)
| | - Jan-Malte Sinning
- University Heart Centre Bonn, Department of Cardiology, Germany (N.W., J-M.S.)
| | - Federico Pappalardo
- San Raffaele Scientific Institute Milan, Anaesthesia and Intensive Care Department, Italy (F.P., M.P.)
| | - Marina Pieri
- San Raffaele Scientific Institute Milan, Anaesthesia and Intensive Care Department, Italy (F.P., M.P.)
| | - Carsten Skurk
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Germany (C.S., A.L., U.L.)
| | - Alexander Lauten
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Germany (C.S., A.L., U.L.)
| | - Ulf Landmesser
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Germany (C.S., A.L., U.L.)
| | - Ralf Westenfeld
- Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Germany (R.W., P.H.)
| | - Patrick Horn
- Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Germany (R.W., P.H.)
| | - Matthias Pauschinger
- Paracelsus Medical University Nürnberg, Department of Cardiology, Germany (M.P., D.E.)
| | - Dennis Eckner
- Paracelsus Medical University Nürnberg, Department of Cardiology, Germany (M.P., D.E.)
| | - Raphael Twerenbold
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T.)
| | - Peter Nordbeck
- University Hospital Würzburg, Department of Internal Medicine I, Germany (P.N., T.S.)
| | - Tim Salinger
- University Hospital Würzburg, Department of Internal Medicine I, Germany (P.N., T.S.)
| | - Peter Abel
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Klaus Empen
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Mathias C. Busch
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Stephan B. Felix
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Jan-Thorben Sieweke
- Hannover Medical School, Department of Cardiology and Angiology, Germany (J.T.S., A.S.)
| | | | - Nilesh Pareek
- King’s College Hospital National Health Service Foundation Trust, London, United Kingdom (N.P., J.H., P.M.)
| | - Jonathan Hill
- King’s College Hospital National Health Service Foundation Trust, London, United Kingdom (N.P., J.H., P.M.)
| | - Philip MacCarthy
- King’s College Hospital National Health Service Foundation Trust, London, United Kingdom (N.P., J.H., P.M.)
| | | | - José P.S. Henriques
- Academic Medical Centre Heart Centre, Academic Medical Centre–University of Amsterdam, the Netherlands (J.P.S.H.)
| | - Sven Möbius-Winkler
- University Hospital Jena, Department of Internal Medicine I, Germany (S.M-W., P.C.S.)
| | - P. Christian Schulze
- University Hospital Jena, Department of Internal Medicine I, Germany (S.M-W., P.C.S.)
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., U.Z., S.S.)
| | - Uwe Zeymer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., U.Z., S.S.)
- Klinikum der Stadt Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany (U.Z.)
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., U.Z., S.S.)
| | - Stefan Blankenberg
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany (S.B., D.W.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Germany (H.T.)
| | - Andreas Schäfer
- Hannover Medical School, Department of Cardiology and Angiology, Germany (J.T.S., A.S.)
| | - Dirk Westermann
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany (S.B., D.W.)
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20
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Kapur NK, Annamalai S, Reyelt L, Karmiy SJ, Razavi AA, Foroutanjazi S, Chennojwala A, Ishikawa K. From bedside to bench and back again: translational studies of mechanical unloading of the left ventricle to promote recovery after acute myocardial infarction. F1000Res 2018; 7:F1000 Faculty Rev-1852. [PMID: 30542612 PMCID: PMC6259487 DOI: 10.12688/f1000research.14597.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 11/20/2022] Open
Abstract
Heart failure is a major cause of global morbidity and mortality. Acute myocardial infarction (AMI) is a primary cause of heart failure due in large part to residual myocardial damage despite timely reperfusion therapy. Since the 1970's, multiple preclinical laboratories have tested whether reducing myocardial oxygen demand with a mechanical support pump can reduce infarct size in AMI. In the past decade, this hypothesis has been studied using contemporary circulatory support pumps. We will review the most recent series of preclinical studies in the field which led to the recently completed Door to Unload ST-segment Elevation Myocardial Infarction (DTU-STEMI) safety and feasibility pilot trial.
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Affiliation(s)
- Navin K. Kapur
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Shiva Annamalai
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lara Reyelt
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Samuel J. Karmiy
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen A. Razavi
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sina Foroutanjazi
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Aditya Chennojwala
- The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York, USA
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21
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[Cardiac support and replacement systems]. Med Klin Intensivmed Notfmed 2017; 112:417-425. [PMID: 28466294 DOI: 10.1007/s00063-017-0295-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
In recent years, the widespread use of partial mechanical cardiac support and even temporary complete replacement of cardiac function has been established in many intensive care units in the treatment of refractory cardiogenic shock. There is a difference between partial left-ventricular assist devices (LVAD) and the possibility of complete heart (and lung) replacement by extra corporeal life support (ECLS). Despite the use of mechanical support devices, the mortality of cardiogenic shock remains high. The consideration of using percutaneous LVAD and ECLS in cardiogenic shock should be considered in refractory cardiogenic shock patients in addition to support by catecholamines and after early revascularization in acute coronary syndromes. However, there are no large randomized studies evaluating mechanical support systems with respect to outcome in cardiogenic shock patients. German and international guidelines do not recommend the routine use of mechanical support as a first-line treatment in cardiogenic shock patients and emphasize that their application should be restricted to patients with therapy refractory shock. In other cases of noninfarct-related cardiogenic shock (e. g., poisoning, myocarditis), ECLS use should be considered as bridging therapy. ECLS may also be considered in cardiopulmonary resuscitation which is termed E‑CPR. According to registry data, E‑CPR may reduce mortality in selected patients. A possible application of ECLS is severe accidental hypothermia with cardiac arrest despite limited data. In these rare cases, early ECLS should be considered for rewarming and stabilization.
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22
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Møller-Helgestad OK, Møller JE. Ventricular Unloading in Porcine Models. JACC Cardiovasc Interv 2017; 10:841. [PMID: 28427603 DOI: 10.1016/j.jcin.2017.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
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23
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Methodological Issues and Their Impact on Conclusions. JACC Cardiovasc Interv 2017; 10:839-841. [PMID: 28427602 DOI: 10.1016/j.jcin.2017.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/13/2017] [Accepted: 01/26/2017] [Indexed: 11/24/2022]
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24
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Reply. JACC Cardiovasc Interv 2017; 10:842-843. [DOI: 10.1016/j.jcin.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
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25
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Kern MJ, Seto AH. Comparing Hemodynamics of Contemporary Mechanical Circulatory Support: Moving From In Silico to In Vivo Results. JACC Cardiovasc Interv 2016; 9:2304-2307. [PMID: 28026741 DOI: 10.1016/j.jcin.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Morton J Kern
- Veterans Administration Long Beach Health Care System, University of California, Long Beach, California.
| | - Arnold H Seto
- Veterans Administration Long Beach Health Care System, University of California, Long Beach, California
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