Effects of left-ventricular assist using a co-axial flow pump (Hemopump) on organ blood flow during experimental cardiogenic shock
- 50 Downloads
The preservation of vital organ function appears to be a critical determinant of long-term outcome in patients treated with ventricular assist devices (VAD). Renal failure and multiple organ failure are among the most frequently reported fatal complications during and following temporary mechanical circulatory assist (MCA) (14, 13). Undoubtedly, reversibility of organ dysfunction is primarily determined by the duration of cardiogenic shock which preceeds the initiation of MCA (17). However, changes in regional blood flow distribution due to the use of MCA devices may play an important role as well. Changes in hormonal and neurotransmitter tone have been reported, and it has been clearly demonstrated that MCA alters blood rheology and fluid homeostasis (5, 19). The significance of pulse pressure, the minimum perfusion pressure, and amount of flow delivered by a VAD required to maintain adequate peripheral blood flow remain to be determined. In animals with normal cardiac function, regional blood flow distribution is well maintained with the use of VAD’s (6) The potential of the various types of MCA, however, to restore regional blood flow distribution following a period of critically disturbed and rapidly deteriorating regional blood flow is still controversial. Sukehiro et al. demonstrated that following a period of severe cardiogenic shock, renal blood flow could not be restored to pre-shock values with the use of a centrifugal, non-pulsatile flow VAD (18).
KeywordsCardiogenic Shock Left Ventricular Assist Device Bronchial Artery Ventricular Assist Device Left Anterior Descend Occlusion
Unable to display preview. Download preview PDF.
- 7.Keppel G (1982) Correction for multiple comparisons. Design and Analysis. Prentice-Hall 144–166Google Scholar
- 8.Kobayashi S, Takahashi H, Nishiyama H, et al (1982) Studies on left ventricular bypass: the preventive measure of excess negative pressure upon the inside of left atrium during left ventricular bypass. Jpn J Artif Organs 11: 131–134Google Scholar
- 10.Lavallee M, Cox D, Patrick TA, Vatner SF (1983) Salvage of myocardial function by coronary artery reperfusion 1, 2, and 3 hours after occlusion in conscious dogs. Cire Res 53: 235–247Google Scholar
- 11.Mackoviack JA, Dasse KA, Poirier VL (1990) Mechanical cardiac assistance and replacement. Heart Transplantation 8: 39–53Google Scholar
- 12.Merhige ME, Smalling RW, Cassidy D, Barret R, Wise G, Short J, Wampler RK (1989) Effect of the Hemopump Left Ventricular Assist Device on Regional Myocardial Perfusion and Function. Circulation 80 (Suppl III): III158–III166Google Scholar
- 17.Schoen FJ, Palmer DC, Bernhard WF, Pennington DG, Haudenschild CC, Ratliff NB, Berger RL, Golding LR, Watson JT (1986) Clinical temporary ventricular assist. Pathologic findings and their implications in a multi-institutional study of 41 patients. J Thorac Cardiovasc Surg 92: 1071–1081PubMedGoogle Scholar
- 20.Vanhaecke J, Flameng W, Borgers M, Jang I, Van de Werf F, De Geest H (1990) Evidence for decreased coronary flow reserve in viable postischemic myocardium. Circulation Research 67Google Scholar
- 21.Van de Werf F, Vanhaecke J, Jang I-K, Flameng W, Collen D, De Geest H (1987) Reduction in infarct size and enhanced recovery of systolic function after coronary thrombolysis with tissue-type plasminogen activator combined with (3-adrenergic blockade with metoprolol. Circulation 75 (4): 830–836PubMedCrossRefGoogle Scholar