Abstract
Background
Referral for high-risk percutaneous coronary intervention (PCI) is a progressively growing trend. Percutaneous Mechanical Circulatory Support (MCS), may protect the myocardium and reduce the risk of major adverse events. Clinical data on Left Ventricular (LV) unloading by pneumatically driven Percutaneous Left Ventricular Assist Devices (pVAD's) is currently scarce.
Purpose
Describe the unloading pattern produced by a pneumatically driven pulsatile pVAD on LV haemodynamics through real-time Pressure-volume (PV) analysis with a conductance catheter positioned in the left ventricle.
Methods
19 patients undergoing high-risk PCI treated with MCS were monitored with PV loops and pulmonary artery catheterization throughout the intervention.
Results
When activated on 1:1 assist ratio, the mean output produced by the pVAD was 1.36±0.13L/min. Compared to pre-implantation, 1:1 support produced a significant reduction in End-systolic Wall Stress (ΔWSes: −11.95%, p<0.01) and PV area (ΔPVA: −16.67%, p<0.01). Contractility did not significantly change (ΔV100: +29.48%, p=0.073; End-systolic Elastance, ΔEes: 1.24%, p=0.86). Effective Arterial Elastance (Ea), representing afterload, decreased (ΔEa: −12.05%, p<0.05). Total Arterial Compliance (ΔTAC: +31.59, p<0.01) increased and Ventricular-arterial Coupling (ΔEa/Ees: −9.79%, p=0.06) non-significantly improved. Mean arterial pressure non-significantly decreased (ΔMAP: −6.66%, p=0.06) and global Cardiac Output remained stable (ΔCO: −0.06%, p=0.37). When the pVAD was removed after the PCI these changes were reversed (Figure 1).
Image 1
Conclusion
High-risk PCI with pneumatic MCS may result in LV unloading and reduced myocardial oxygen consumption. Further insights will be released in the PULSE trial (Clinicaltrials.gov NCT03200990).
Left ventricular assist devices in acute cardiovascular care patients and high-risk percutaneous coronary interventions
