Mechanical left ventricular unloading during high risk coronary angioplasty: First use of a new percutaneous transvalvular left ventricular assist device

Abstract

A new catheter mounted, transvalvular left ventricular assist device has been designed for percutaneous transfemoral access. The device, the Hemopump [14 French (Fr.) outer diameter], is based on a mixed flow rotary pump and is capable of flow rates of 1.5-2.2 l/min. The pump is inserted using a specialized 16 Fr. femoral introducer sheath. The first application of the percutaneous Hemopump in man was performed in two patients with hemodynamic compromise during high risk coronary angioplasty. In these patients, Hemopump support resulted in hemodynamic stabilization (increase in aortic pressure from 60/42 to 87/61 and from 80/60 to 100/70 mm Hg, respectively) and marked left ventricular unloading (decrease in pulmonary capillary wedge pressure from 25 to 10 and from 14 to 10 mm Hg) during balloon inflation. In both patients, percutaneous transluminal coronary angioplasty (PTCA) could be accomplished successfully. Using the system for periods of about 2 hr in each patient, we observed no vascular, hemorrhagic, or embolic complications. In both patients, only a minor increase in both plasma free hemoglobin and lactate dehydrogenase levels was noted. Our preliminary experiences suggest that the percutaneous Hemopump is safe and effective and may be a powerful alternative to other devices used for supported angioplasty.

Left-Ventricular Unloading by Transvalvular Axial Flow Pumping in Experimental Cardiogenic Shock and during Regional Myocardial Ischemia

“…2). Insertion of this device is easy and can be rapidly performed in the cath eterization laboratory [19]. Our preliminary animal experimental results demonstrate clear evidence of myocardial protection using the 14-Fr HP during acute regional myocar dial ischemia [20], In accordance with these experimental results, we observed beneficial hemodynamic effects using the percutaneous HP in first pilot studies during PTCA in highrisk patients [19].…”

“…Insertion of this device is easy and can be rapidly performed in the cath eterization laboratory [19]. Our preliminary animal experimental results demonstrate clear evidence of myocardial protection using the 14-Fr HP during acute regional myocar dial ischemia [20], In accordance with these experimental results, we observed beneficial hemodynamic effects using the percutaneous HP in first pilot studies during PTCA in highrisk patients [19]. In addition to prophylactic support during angioplasty, this percutaneous HP may be useful in the treatment of acute myocardial infarction shock and in patients with end-stage heart failure awaiting cardiac transplantation.…”

Need for Active Left-Ventricular Decompression during Percutaneous Cardiopulmonary Support in Cardiac Arrest

“…Thus, direct ret rograde transaortic LV venting during PCPS supported fibrillation would require higher flow rates. In the future, this could possibly be managed using the new percutaneous transvalvular LV assist system Hemopump®, which is 14 Fr in maximum outside diameter and, due to the length of the left-ventricular suction cannula of only 8 cm, is capable of producing higher flow rates (about 2 liters/ min) [14], Transseptal cannulation using a modified Brockenborough catheter (12 Fr in outer diameter) could be a potential alterna tive method of direct left-ventricular decom pression without the risk of deleterious aortic valve incompetency. However, with both methods experimental experience is needed.…”

Circulatory Support Devices in Clinical Cardiology

“…This device is available in three sizes, 14-Fr, 21-Fr and 26-Fr catheters with variable maximal pump rates. While the 14-Fr devices can be im planted by a percutaneous Seldinger tech nique [19], the 21-Fr device needs a surgical cut down of the femoral artery, and the 26-Fr device a thoracotomy.…”