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Abstract
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<h5 class="section-title" id="d3069774e173">OBJECTIVES</h5>
<p id="P1">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.
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<h5 class="section-title" id="d3069774e178">BACKGROUND</h5>
<p id="P2">Percutaneous support devices offer the ability to unload the ischemic left
ventricle,
but the comparative hemodynamic effects of contemporary platforms are unclear.
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<h5 class="section-title" id="d3069774e183">METHODS</h5>
<p id="P3">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.
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<h5 class="section-title" id="d3069774e188">RESULTS</h5>
<p id="P4">Myocardial infarction produced a rightward shift of the PV loop and increased
LV end-diastolic
pressure (from 9 ± 2 mmHg 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/dt
<sub>max</sub> (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).
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<h5 class="section-title" id="d3069774e196">CONCLUSIONS</h5>
<p id="P5">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.
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