Effects of left-ventricular assist using a co-axial flow pump (Hemopump) on organ blood flow during experimental cardiogenic shock

Abstract

The preservation of vital organ function appears to be a critical determinant of long-term outcome in patients treated with ventricular assist devices (VAD). Renal failure and multiple organ failure are among the most frequently reported fatal complications during and following temporary mechanical circulatory assist (MCA) (14, 13). Undoubtedly, reversibility of organ dysfunction is primarily determined by the duration of cardiogenic shock which preceeds the initiation of MCA (17). However, changes in regional blood flow distribution due to the use of MCA devices may play an important role as well. Changes in hormonal and neurotransmitter tone have been reported, and it has been clearly demonstrated that MCA alters blood rheology and fluid homeostasis (5, 19). The significance of pulse pressure, the minimum perfusion pressure, and amount of flow delivered by a VAD required to maintain adequate peripheral blood flow remain to be determined. In animals with normal cardiac function, regional blood flow distribution is well maintained with the use of VAD’s (6) The potential of the various types of MCA, however, to restore regional blood flow distribution following a period of critically disturbed and rapidly deteriorating regional blood flow is still controversial. Sukehiro et al. demonstrated that following a period of severe cardiogenic shock, renal blood flow could not be restored to pre-shock values with the use of a centrifugal, non-pulsatile flow VAD (18).