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Hemodynamic Effects of Mechanical Circulatory Support Devices in Ventricular Septal Defect.
- Source :
-
Circulation. Heart failure [Circ Heart Fail] 2019 Jul; Vol. 12 (7), pp. e005981. Date of Electronic Publication: 2019 Jul 12. - Publication Year :
- 2019
-
Abstract
- Background: Ventricular septal defect (VSD) is a lethal complication of acute myocardial infarction (AMI) and is often associated with cardiogenic shock. The optimal form of percutaneous mechanical circulatory support (MCS) for AMI-VSD is unknown.<br />Methods and Results: We used a previously validated cardiovascular model to simulate AMI-VSD with parameters adjusted to replicate average hemodynamics reported in the literature, including a pulmonary-to-systemic blood flow ratio of 3.0. We then predicted effects of different types of percutaneous MCS (including intra-aortic balloon pumping, Impella, TandemHeart, and extracorporeal membrane oxygenation) on pressures and flows throughout the cardiovascular system. The simulation replicated all major hemodynamic parameters reported in the literature with AMI-VSD. Inotropes and vasopressors worsened left-to-right shunting, whereas vasodilators decreased shunting at the expense of worsening hypotension. All MCS devices increased forward blood flow and arterial pressure but other effects varied among devices. Impella 5.0 provided the greatest degree of pulmonary capillary wedge pressure reductions and decreased left-to-right shunting. Extracorporeal membrane oxygenation worsened pulmonary capillary wedge pressure and shunting, which could be improved by adding Impella or passive left ventricular vent. Pulmonary-to-systemic blood flow ratio could not be reduced below 2.0, and pulmonary flows remained high with all forms of MCS.<br />Conclusions: Although no form of percutaneous MCS normalized hemodynamics in AMI-VSD, pulmonary capillary wedge pressure and shunting were worsened by extracorporeal membrane oxygenation and improved by Impella. Accordingly, based on hemodynamics alone, Impella provides the optimal form of support in AMI-VSD. However, other factors, including team experience, device availability, potential for tissue ingestion, and clinical characteristics, need to be considered when choosing a percutaneous MCS device for AMI-VSD.
- Subjects :
- Adult
Aged
Aged, 80 and over
Extracorporeal Membrane Oxygenation instrumentation
Extracorporeal Membrane Oxygenation methods
Female
Heart Failure physiopathology
Heart Septal Defects, Ventricular physiopathology
Heart Ventricles physiopathology
Hemodynamics physiology
Humans
Intra-Aortic Balloon Pumping adverse effects
Male
Middle Aged
Myocardial Infarction physiopathology
Risk Factors
Shock, Cardiogenic physiopathology
Shock, Cardiogenic surgery
Heart Failure surgery
Heart Septal Defects, Ventricular surgery
Heart Ventricles surgery
Heart-Assist Devices adverse effects
Myocardial Infarction surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1941-3297
- Volume :
- 12
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Circulation. Heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 31296094
- Full Text :
- https://doi.org/10.1161/CIRCHEARTFAILURE.119.005981