Organ perfusion with hemopump device assistance with and without intraaortic balloon pumping Bart Meyns, MD, Yousuke Nishimura, MD, Rozalia Racz, MD,

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Presentation transcript:

Organ perfusion with hemopump device assistance with and without intraaortic balloon pumping Bart Meyns, MD, Yousuke Nishimura, MD, Rozalia Racz, MD, Ramadan Jashari, MD, Willem Flameng, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 114, Issue 2, Pages 243-253 (August 1997) DOI: 10.1016/S0022-5223(97)70152-1 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 Experimental protocol setup. 1, Hemopump flow is diverted through Y-graft and measured by electromagnetic flowmeter; 2, intraaortic balloon is inserted through femoral artery. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Experimental protocol. Colored microspheres are injected at five different times. Modes of mechanical support (Hemopump device alone and Hemopump device with IABP) alternated between experiments. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The heart is cut into five slices. Each slice is unrolled into a myocardial strip. Colored microsphere content is analyzed in subendocardial and subepicardial biopsy samples from three right ventricular (rv) and nine left ventricular (lv) regions. Regions lv4, lv5, and lv6 are ischemic regions when the lateral branch of the left coronary artery is stenosed. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Mean Hemopump flow (± standard error) without (closed circles) and with (open circles) IABP for different rotational speeds. Difference is significant when pump is turned off and at speed 1. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Left ventricular pressure, aortic blood pressure, Hemopump flow and electrocardiographic (ECG) tracing during Hemopump run with 1 in 2 counterpulsation assist. Diastolic pressure (arrow) augmented by the intraaortic balloon causes a drop in Hemopump flow (arrow). Systolic peak flows remain unchanged. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Hemodynamic changes during ischemia and mechanical support. A, Systolic blood pressure; B, diastolic blood pressure; C, left atrial pressure; and D, cardiac output for Hemopump device alone (closed circles) and Hemopump device with IABP (open circles). Only diastolic blood pressure during assistance with both Hemopump device and IABP shows significant change (asterisk). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Maximum and minimum values of first derivative of left ventricular pressure (dp/dt max and min) for Hemopump device alone (closed circles) and Hemopump device with IABP (open circles). Significant differences from control value are indicated by asterisks. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 8 Wall thickening of lateral wall of left ventricle for Hemopump device alone (closed circles) and Hemopump device with IABP (open circles). Significant difference from control value is indicated by asterisk. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 9 Subendocardial blood flow in 12 different regions of myocardial slice (see Fig. 3). Regions from right ventricle are rva, rvl, and rvp; lv1 through lv9 are from left ventricle. Each panel shows myocardial perfusion in control situation (closed diamonds), during ischemia (open circles), and during mechanical support (closed squares). Asterisks indicate significant differences from the control value. A, Hemopump device with IABP; B, Hemopump device alone. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 10 Subepicardial blood flow in 12 different regions of myocardial slice (see Fig. 3). Regions from right ventricle are rva, rvl, and rvp; lv1 through lv9 are from left ventricle. Each panel shows myocardial perfusion in control situation (closed diamonds), during ischemia (open circles), and during mechanical support (closed squares). Asterisks indicate significant differences from the control value. A, Hemopump device with IABP; B, Hemopump device alone. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 11 Ratio of subendocardial to subepicardial blood flow in 12 different regions of myocardial slice (see Fig. 3). Regions from right ventricle are rva, rvl, and rvp; lv1 through lv9 are from left ventricle. Each panel shows myocardial perfusion in control situation (closed diamonds), during ischemia (open circles), and during mechanical support (closed squares). Asterisks indicate significant differences from the control value. A, Hemopump device with IABP; B, Hemopump device alone. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 243-253DOI: (10.1016/S0022-5223(97)70152-1) Copyright © 1997 Mosby, Inc. Terms and Conditions