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Published on: June 12, 2021
Acute hemodynamic efficacy of a 32-ml subcutaneous counterpulsation device in a calf model of diminished cardiac
Steven C Koenig1, Kenneth N Litwak, Guruprasad A Giridharan
1Department of Bioengineering, Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky 40202, USA. sckoen01@gwise.louisville.edu
Insights
A new implantable counterpulsation device (CPD) shows hemodynamic efficacy comparable to intra-aortic balloon pumps (IABP). This device may offer a therapeutic option for patients needing prolonged circulatory support.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- Diminished cardiac function (DCF) necessitates circulatory support.
- Intra-aortic balloon pumps (IABP) are a standard treatment.
- Novel devices are needed for improved counterpulsation therapy.
Purpose of the Study:
- To evaluate the acute hemodynamic efficacy of a novel implantable counterpulsation device (CPD).
- To compare the CPD's performance against a standard IABP in a preclinical model.
Main Methods:
- A 32-ml stroke volume CPD was tested in calves (n=10) with Monensin-induced DCF.
- Hemodynamic parameters, including cardiac output and left ventricular external work, were measured.
- Coronary artery flow and myocardial oxygen consumption were assessed and compared to IABP.
Main Results:
- CPD and IABP demonstrated similar increases in cardiac output and reductions in left ventricular external work.
- CPD showed a greater ratio of diastolic coronary artery flow to left ventricular external work increase.
- CPD achieved a greater reduction in myocardial oxygen consumption compared to IABP.
Conclusions:
- The implantable counterpulsation device (CPD) offers hemodynamic efficacy equivalent to IABP.
- CPD may be a viable therapeutic option for prolonged counterpulsation.
- The device showed no early signs of adverse effects like hemolysis or thrombus formation.
Abstract:
The acute hemodynamic efficacy of an implantable counterpulsation device (CPD) was evaluated. The CPD is a valveless single port, 32-ml stroke volume blood chamber designed to be connected to the human axillary artery using a simple surface surgical procedure. Blood is drawn into the pump during systole and ejected during diastole. The acute hemodynamic effects of the 32-ml CPD were compared to a standard clinical 40-ml intra-aortic balloon pump (IABP) in calves (80 kg, n = 10). The calves were treated by a single oral dose of Monensin to produce a model of diminished cardiac function (DCF). The CPD and IABP produced similar increases in cardiac output (6% CPD vs. 5% IABP, p > 0.5) and reduction in left ventricular external work (14% CPD vs. 13% IABP, p > 0.5) compared to DCF (p < 0.05). However, the ratio of diastolic coronary artery flow to left ventricular external work increase from DCF baseline (p < 0.05) was greater with the CPD compared to the IABP (15% vs. 4%, p < 0.05). The CPD also produced a greater reduction in left ventricular myocardial oxygen consumption from DCF baseline (p < 0.05) compared to the IABP (13% vs. 9%, p < 0.05) despite each device providing similar improvements in cardiac output. There was no early indication of hemolysis, thrombus formation, or vascular injury. The CPD provides hemodynamic efficacy equivalent to an IABP and may become a therapeutic option for patients who may benefit from prolonged counterpulsation.
