Left Ventricular Mechanical Unloading by Total Support of Impella in Myocardial Infarction Reduces Infarct Size, Preserves Left Ventricular Function, and Prevents Subsequent Heart Failure in Dogs
Left Ventricular Mechanical Unloading by Total Support of Impella in Myocardial Infarction Reduces Infarct Size, Preserves Left Ventricular Function, and Prevents Subsequent Heart Failure in Dogs
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DOI：
10.1161/circheartfailure.117.004397
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发表时间：
2018-05-01
影响因子：
9.7
通讯作者：
Sunagawa, Kenji
中科院分区：
文献类型：
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作者：
Saku, Keita;Kakino, Takamori;Sunagawa, Kenji
背景：急性心肌梗死仍然是慢性心力衰竭的主要原因。心肌需氧量相对于供氧量过高是心肌梗死的根本机制。因此，我们假设在经血管左室辅助装置Impella的全面支持下，左室（LV）机械卸载可以减少氧需求，从而减少梗死面积并预防随后的心力衰竭。方法与结果：20只犬结扎左冠状动脉前降支180分钟后再灌注。我们从缺血开始后60分钟至再灌注后60分钟开始使用Impella。在部分支持组，Impella支持总心输出量的50%。在总支持群体中，系统流完全依赖于Impella流。缺血再灌注（I/R） 4周后，我们比较了4组左室功能和梗死面积：假手术（无I/R）、I/R（无Impella支持）、部分支持和完全支持。与I/R相比，总支持降低左室舒张末压（15.0 +/- 3.5 vs 4.7 +/- 1.7 mmHg）
BACKGROUND: Acute myocardial infarction remains a leading cause of chronic heart failure. Excessive myocardial oxygen demand relative to supply is the fundamental mechanism of myocardial infarction. We thus hypothesized that left ventricular (LV) mechanical unloading by the total support of transvascular LV assist device Impella could minimize oxygen demand, thereby reducing infarct size and preventing subsequent heart failure.METHODS AND RESULTS: In 20 dogs, we ligated the left anterior descending coronary artery for 180 minutes and then reperfused. We introduced Impella from 60 minutes after the onset of ischemia to 60 minutes after reperfusion. In the partial support group, Impella supported 50% of total cardiac output. In the total support group, systemic flow totally depends on Impella flow. Four weeks after ischemia/reperfusion (I/R), we compared LV function and infarct size among 4 groups: sham (no I/R), I/R (no Impella support), partial support, and total support. Compared with I/R, total support lowered LV end-diastolic pressure (15.0 +/- 3.5 versus 4.7 +/- 1.7 mmHg; P