983-32 In Vivo Validation of the Hand Pump for Active Distal Coronary Perfusion During Balloon Angioplasty in Comparison to Autoperfusion Catheters

Abstract

Standard autoperfusion catheters allow passive distal coronary perfusion during balloon angioplasty (PTCA) at a reported maximum range of 40 to 60 ml/min. The hand pump uses an active perfusion technique by withdrawing blood from the guiding catheter and reinjection through the wire lumen of a standard over-the-wire balloon catheter into the distal vessel. Perfusion is performed by pulling and pushing the system's piston and is depending on the applied driving pressure. To test this active perfusion device. heart rate (HR). mean aortic pressure (AP), dp/dt. regional coronary blood flow (electromagnetic flow, EMF) distal to the balloon, systolic regional wall thickening related to the occluded vessel (sonomicrometry, WT). and distal coronary perfusion pressure (CPP) were measured in 6 open chest dogs. Measurements were performed at baseline, during two minutes balloon occlusions (3.0 mm balloon catheter, 6atm) of the left circumflex artery without and with application of the hand pump at different driving pressures (100 psi, 200 psi, 300 psi and 400 psi), and during two minutes application of a standard 3.0 mm autoperfusion catheter (APC) at 6atm. Before each measurement baseline hemodynamics were established. Results: baseline occlusion hand pump APC 100 psi 200 psi 300 psi 400 psi HR 116.8 124.0 118.9 120.5 117.6 119.2 129.2 [bpm] ±11.4 ±14.7 ±16.3 ±16.3 ±3.1 ±15.7 ±16.9 AP 93.6 82.0 79.3 80.8 74.2 91.8 76.7 [mmHg] ±9.3 ±14.4 ±7.4 ±12.8 ±11.5 ±14.0 ±22.5 dp/dt 1662 1209 1544 1659 1715 1728 1416 [mmHg/s] ±356 ±435 ±316 ±369 ±567 ±409 ±400 EMF 48.9 0 30.7 45.6 # 49.3 # 64.1 # 17.3 [ml/min] ±28.1 ±37.8 ±43.6 ±46.0 ±54.1 ±9.1 WT 16.4 –2.7 3.2 5.7 10.2 # 10.9 # 2.4 [%] ±4.5 ±4.6 ±6.8 ±5.2 ±2.5 ±2.4 ±5.3 CPP 87.7 35.4 49.8 56.1 79.5 # 101.7 # 47.5 [mmHg] ±14.1 ±33.6 ±31.8 ±26.1 ±445 ±61.3 ±48.0 # P < 0.05 vs. occlusion by ANOVA Close correlations were calculated between applied driving pressures to the hand pump and measured changes in dp/dt (r = 0.889). EMF (r = 0.948). WT (r = 0.972) and CPP (r = 0.801). The hand pump provides. depending on the applied driving pressure. better distal coronary perfusion. hemodynamics and maintenance of wall motion during PTCA compared to autoperfusion catheters.