Extracorporeal membrane oxygenation versus counterpulsatile, pulsatile, and continuous left ventricular unloading for pediatric mechanical circulatory support. Pediatr Crit Care Med 2013 Nov;14(9):e424-37
Date
10/11/2013Pubmed ID
24108116Pubmed Central ID
PMC3913264DOI
10.1097/PCC.0b013e3182a551b0Scopus ID
2-s2.0-84892807632 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
OBJECTIVES: Despite progress with adult ventricular assist devices, limited options exist to support pediatric patients with life-threatening heart disease. Extracorporeal membrane oxygenation remains the clinical standard. To characterize (patho)physiologic responses to different modes of mechanical unloading of the failing pediatric heart, extracorporeal membrane oxygenation was compared to intra-aortic balloon pump, pulsatile-flow ventricular assist device, or continuous-flow ventricular assist device support in a pediatric heart failure model.
DESIGN: Experimental.
SETTING: Large animal laboratory operating room.
SUBJECTS: Yorkshire piglets (n = 47; 11.7 ± 2.6 kg).
INTERVENTIONS: In piglets with coronary ligation-induced cardiac dysfunction, mechanical circulatory support devices were implanted and studied during maximum support.
MEASUREMENTS AND MAIN RESULTS: Left ventricular, right ventricular, coronary, carotid, systemic arterial, and pulmonary arterial hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption and total-body oxygen consumption were calculated from arterial, venous, and coronary sinus blood sampling. Blood flow was measured in 17 organs with microspheres. Paired Student t tests compared baseline and heart failure conditions. One-way repeated-measures analysis of variance compared heart failure, device support mode(s), and extracorporeal membrane oxygenation. Statistically significant (p < 0.05) findings included 1) an improved left ventricular blood supply/demand ratio during pulsatile-flow ventricular assist device, continuous-flow ventricular assist device, and extracorporeal membrane oxygenation but not intra-aortic balloon pump support, 2) an improved global myocardial blood supply/demand ratio during pulsatile-flow ventricular assist device and continuous-flow ventricular assist device but not intra-aortic balloon pump or extracorporeal membrane oxygenation support, and 3) diminished pulsatility during extracorporeal membrane oxygenation and continuous-flow ventricular assist device but not intra-aortic balloon pump and pulsatile-flow ventricular assist device support. A profile of systems-based responses was established for each type of support.
CONCLUSIONS: Each type of pediatric ventricular assist device provided hemodynamic support by unloading the heart with a different mechanism that created a unique profile of physiological changes. These data contribute novel, clinically relevant insight into pediatric mechanical circulatory support and establish an important resource for pediatric device development and patient selection.
Author List
Bartoli CR, Koenig SC, Ionan C, Gillars KJ, Mitchell ME, Austin EH 3rd, Gray LA, Pantalos GMAuthor
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AnimalsAorta
Carotid Arteries
Coronary Vessels
Extracorporeal Membrane Oxygenation
Heart Failure
Heart Ventricles
Heart-Assist Devices
Hemodynamics
Intra-Aortic Balloon Pumping
Oxygen Consumption
Pulsatile Flow
Renal Circulation
Swine
