Predicted hemodynamic benefits of counterpulsation therapy using a superficial surgical approach
Predicted hemodynamic benefits of counterpulsation therapy using a superficial surgical approach
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DOI：
10.1097/01.mat.0000196522.29376.96
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发表时间：
2006-01-01
期刊：
影响因子：
4.2
通讯作者：
Koenig, SC
中科院分区：
文献类型：
--
作者：
Giridharan, GA;Pantalos, GM;Koenig, SC
提出了一种用于通过浅表手术入路长期植入的容积置换反搏装置（CPD）。CPD是一种由心脏驱动的囊，在自体心脏收缩期充满，在心脏舒张期通过一根与锁骨下动脉相连的无瓣膜插管排空。在临床相关的早期心力衰竭模型中，进行计算机模拟以预测和比较CPD对主动脉内球囊反搏（IABP）的生理反应。研究了器械每搏输出量（0-50 ml）和控制模式（时间、持续时间、形态）对标志性血流动力学参数和LV压力-容积关系的影响。模拟结果预测，CPD将提供与IABP相当的血流动力学受益，如舒张期峰值主动脉压增加高达25%所证明的，这将使舒张期冠状动脉灌注增加高达34%。CPD还可使LV舒张末期压降低34%，收缩期峰值主动脉压降低12%，使LV工作负荷降低26%，心输出量增加10%。这项研究表明，在早期心力衰竭患者中，浅表CPD技术可以急性使用，以实现与IABP相似的血流动力学功能改善。
A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0-50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure-volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients.