Effects of Impella on Coronary Perfusion in Patients With Critical Coronary Artery Stenosis

被引:42
作者
Alqarqaz, Mohammad [1 ]
Basir, Mir [1 ]
Alaswad, Khaldoon [1 ]
O'Neill, William [1 ]
机构
[1] Henry Ford Hosp, Detroit, MI 48202 USA
关键词
arterial pressure; blood pressure; coronary vessels; heart; hemodynamics; INTRAAORTIC BALLOON COUNTERPULSATION; BLOOD-FLOW; HEMODYNAMIC SUPPORT; CARDIOPULMONARY RESUSCITATION; PROTECT II; PRESSURE; INTERVENTION; AUGMENTATION; ANGIOPLASTY; PHYSIOLOGY;
D O I
10.1161/CIRCINTERVENTIONS.117.005870
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Mechanical circulatory support devices are used to maintain hemodynamic stability during high-risk percutaneous coronary interventions. Little is known on the effects of such devices on coronary hemodynamics in patients with significant coronary stenosis. We sought to investigate whether mechanical circulatory support in the form of Impella (Abiomed Inc, Danvers, MA) can improve coronary hemodynamics in the presence of a critical coronary stenosis. Methods and Results-We examined coronary perfusion pressures and coronary pressure distal to a critical stenosis using a coronary pressure wire in 11 patients (12 coronary lesions) undergoing high-risk percutaneous coronary interventions with the use of mechanical circulatory support. Systemic, ventricular, and coronary hemodynamics were obtained at both minimum and maximum support levels before high-risk percutaneous coronary interventions. All patients had obstructive lesions with angiographically estimated diameter stenosis between 70% and 99% and distal coronary artery pressure to aortic pressure ratios between 0.44 and 0.88. When compared with minimum support, maximum support resulted in a decrease in the left ventricular end-diastolic pressure (27.3 +/- 8.6 versus 21.5 +/- 5.2 mm Hg; P=0.002) and increases in the mean systemic blood pressure (77.6 +/- 13.5 versus 88.2 +/- 12.2 mm Hg; P<0.001) and mean distal coronary pressure (51.8 +/- 20.2 versus 60.8 +/- 18.1 mm Hg; P<0.001). Effective coronary perfusion pressure (mean aortic pressure-left ventricular end-diastolic pressure) significantly increased with maximum support (49.8 +/- 15.7 versus 67.2 +/- 13.6 mm Hg; P<0.001). Diastolic perfusion pressure (diastolic blood pressure-left ventricular end-diastolic pressure) also significantly increased with maximum support (32.9 +/- 13.4 versus 52.0 +/- 11.6 mm Hg; P<0.001). Conclusions-Mechanical circulatory support with Impella can improve distal coronary pressure and coronary perfusion pressures in the presence of critical coronary stenosis.
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页数:8
相关论文
共 26 条
[1]  
Anderson RD, 1996, CARDIOLOGY, V87, P306
[2]   The science behind percutaneous hemodynamic support: A review and comparison of support strategies [J].
Burkhoff, Daniel ;
Naidu, Srihari S. .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2012, 80 (05) :816-829
[3]   Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group [J].
Burzotta, Francesco ;
Trani, Carlo ;
Doshi, Sagar N. ;
Townend, Jonathan ;
van Geuns, Robert Jan ;
Hunziker, Patrick ;
Schieffer, Bernhard ;
Karatolios, Konstantinos ;
Moller, Jacob Eifer ;
Ribichini, Flavio L. ;
Schaefer, Andreas ;
Henriques, Jose P. S. .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2015, 201 :684-691
[4]   Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity [J].
Casadonte, Lorena ;
Verhoeff, Bart-Jan ;
Piek, Jan J. ;
VanBavel, Ed ;
Spaan, Jos A. E. ;
Siebes, Maria .
BASIC RESEARCH IN CARDIOLOGY, 2017, 112 (06)
[5]   Coronary and Microvascular Physiology During Intra-Aortic Balloon Counterpulsation [J].
De Silva, Kalpa ;
Lumley, Matthew ;
Kailey, Balrik ;
Alastruey, Jordi ;
Guilcher, Antoine ;
Asrress, Kaleab N. ;
Plein, Sven ;
Marber, Michael ;
Redwood, Simon ;
Perera, Divaka .
JACC-CARDIOVASCULAR INTERVENTIONS, 2014, 7 (06) :631-640
[6]   Regulation of coronary blood flow during exercise [J].
Duncker, Dirk J. ;
Bache, Robert J. .
PHYSIOLOGICAL REVIEWS, 2008, 88 (03) :1009-1086
[7]   Coronary artery blood flow: Physiologic and pathophysiologic regulation [J].
Feliciano, L ;
Henning, RJ .
CLINICAL CARDIOLOGY, 1999, 22 (12) :775-786
[8]   Left Ventricular Mechanical Support with Impella Provides More Ventricular Unloading in Heart Failure Than Extracorporeal Membrane Oxygenation [J].
Kawashima, Dai ;
Gojo, Satoshi ;
Nishimura, Takashi ;
Itoda, Yoshihumi ;
Kitahori, Kazuo ;
Motomura, Noboru ;
Morota, Tetsuro ;
Murakami, Arata ;
Takamoto, Shinichi ;
Kyo, Shunei ;
Ono, Minoru .
ASAIO JOURNAL, 2011, 57 (03) :169-176
[9]   AUGMENTATION OF CORONARY BLOOD-FLOW BY INTRAAORTIC BALLOON PUMPING IN PATIENTS AFTER CORONARY ANGIOPLASTY [J].
KERN, MJ ;
AGUIRRE, F ;
BACH, R ;
DONOHUE, T ;
SIEGEL, R ;
SEGAL, J .
CIRCULATION, 1993, 87 (02) :500-511
[10]   Effects of intraaortic balloon pumping on septal arterial blood flow velocity waveform during severe left main coronary artery stenosis [J].
Kimura, A ;
Toyota, E ;
Lu, SF ;
Goto, M ;
Yada, T ;
Chiba, Y ;
Ebata, J ;
Tachibana, H ;
Ogasawara, Y ;
Tsujioka, K ;
Kajiya, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 27 (04) :810-816