Article (Scientific journals)
Continuous aortic flow augmentation - A pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure
Konstam, M. A.; Czerska, B.; Bohm, M. et al.
2005In Circulation, 112 (20), p. 3107-3114
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Keywords :
heart failure; hemodynamics; vasodilation; nitric oxide; heart-assist device
Abstract :
[en] Background - Diminished aortic flow may induce adverse downstream vascular and renal signals. Investigations in a heart failure animal model have shown that continuous aortic flow augmentation ( CAFA) achieves hemodynamic improvement and ventricular unloading, which suggests a novel therapeutic approach to patients with heart failure exacerbation that is inadequately responsive to medical therapy. Methods and Results - We studied 24 patients ( 12 in Europe and 12 in the United States) with heart failure exacerbation and persistent hemodynamic derangement despite intravenous diuretic and inotropic and/or vasodilator treatment. CAFA ( mean +/- SD 1.34 +/- 0.12 L/min) was achieved through percutaneous ( n = 19) or surgical ( n = 5) insertion of the Cancion system, which consists of inflow and outflow cannulas and a magnetically levitated and driven centrifugal pump. Hemodynamic improvement was observed within 1 hour. Systemic vascular resistance decreased from 1413 +/- 453 to 1136 +/- 381 dyne (.) s (.) cm(-5) at 72 hours ( P = 0.0008). Pulmonary capillary wedge pressure decreased from 28.5 +/- 4.9 to 19.8 +/- 7.0 mm Hg ( P < 0.0001), and cardiac index ( excluding augmented aortic flow) increased from 1.97 +/- 0.44 to 2.27 +/- 0.43 L (.) min(-1) (.) m(-2) ( P = 0.0013). Serum creatinine trended downward during treatment ( overall P = 0.095). There were 8 complications during treatment, 7 of which were self-limited. Hemodynamics remained improved 24 hours after CAFA discontinuation. Conclusions - In patients with heart failure and persistent hemodynamic derangement despite intravenous inotropic and/or vasodilator therapy, CAFA improved hemodynamics, with a reduction in serum creatinine. CAFA represents a promising, novel mode of treatment for patients who are inadequately responsive to medical therapy. The clinical impact of the observed hemodynamic improvement is currently being explored in a prospective, randomized, controlled trial.
Disciplines :
Cardiovascular & respiratory systems
Hematology
Author, co-author :
Konstam, M. A.
Czerska, B.
Bohm, M.
Oren, R. M.
Sadowski, J.
Khanal, S.
Abraham, W. T.
Wasler, A.
Dahm, J. B.
Gavazzi, A.
Gradinac, S.
Legrand, Victor ;  Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
Mohacsi, P.
Poelzl, G.
Radovancevic, B.
Van Bakel, A. B.
Zile, M. R.
Cabuay, B.
Bartus, K.
Jansen, P.
More authors (10 more) Less
Language :
English
Title :
Continuous aortic flow augmentation - A pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure
Publication date :
15 November 2005
Journal title :
Circulation
ISSN :
0009-7322
eISSN :
1524-4539
Publisher :
Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania
Volume :
112
Issue :
20
Pages :
3107-3114
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 22 May 2014

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