Abstract
Introduction:Venoarterial extracorporeal membrane oxygenation is widely used as mechanical circulatory support for severe heart failure. A major concern with this treatment modality is left ventricular distension due to inability to overcome the afterload created by the extracorporeal membrane oxygenation circuit. The present porcine study evaluates coronary circulation, myocardial perfusion and ventricular distension during venoarterial extracorporeal membrane oxygenation.Methods:Ten anesthetized open-chest pigs were cannulated and put on cardiopulmonary bypass. Heart failure was achieved by 90 minutes of aortic cross-clamping with insufficient cardioplegic protection. After declamping, the animals were supported by venoarterial extracorporeal membrane oxygenation for 3 hours. Continuous haemodynamic measurements were performed at baseline, during cardiopulmonary bypass/aortic cross-clamping and during venoarterial extracorporeal membrane oxygenation. Fluorescent microsphere injections at baseline and after 1, 2 and 3 hours on venoarterial extracorporeal membrane oxygenation evaluated myocardial perfusion. Left ventricular function and distension were assessed by epicardial echocardiography.Results:The myocardial injury caused by 90 minutes of ischaemia resulted in a poorly contracting myocardium, necessitating venoarterial extracorporeal membrane oxygenation in all animals. The circulatory support maintained the mean arterial blood pressure within a satisfactory range. A hyperaemic left anterior descending coronary artery flow while on extracorporeal membrane oxygenation was observed compared to baseline. Myocardial tissue perfusion measured by microspheres was low, especially in the subendocardium. Echocardiography revealed myocardial tissue oedema, a virtually empty left ventricle, and a left ventricular output that remained negligible throughout the extracorporeal membrane oxygenation run.Conclusion:Coronary artery blood flow is maintained during venoarterial extracorporeal membrane oxygenation after cardiopulmonary bypass and cardioplegic arrest despite severely affected performance of the left ventricle. Myocardial perfusion decreases, however, presumably due to rapid development of myocardial tissue oedema.
Highlights
Venoarterial extracorporeal membrane oxygenation is widely used as mechanical circulatory support for severe heart failure
The aim of the present study is to evaluate an animal model for critical post-cardiotomy failure and VA-ECMOsupported circulation, focusing on the relationship between left ventricular distension, coronary circulation and myocardial perfusion early after aortic declamping
During aortic cross-clamping, mean aortic blood pressure was slightly lower than at baseline, but stable (Figure 1). Both central venous pressure (CVP) and body temperature remained within normal range
Summary
Venoarterial extracorporeal membrane oxygenation is widely used as mechanical circulatory support for severe heart failure. The present porcine study evaluates coronary circulation, myocardial perfusion and ventricular distension during venoarterial extracorporeal membrane oxygenation. Continuous haemodynamic measurements were performed at baseline, during cardiopulmonary bypass/aortic cross-clamping and during venoarterial extracorporeal membrane oxygenation. Echocardiography revealed myocardial tissue oedema, a virtually empty left ventricle, and a left ventricular output that remained negligible throughout the extracorporeal membrane oxygenation run. Conclusion: Coronary artery blood flow is maintained during venoarterial extracorporeal membrane oxygenation after cardiopulmonary bypass and cardioplegic arrest despite severely affected performance of the left ventricle. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become an important treatment modality in patients with cardiogenic shock.[1] In cardiac surgery, VA-ECMO is used as temporary circulatory support for days or weeks if weaning from the heart–lung machine is problematic.[2] VA-ECMO has the potential of Perfusion 35(8). Echocardiographic evaluation would reveal left ventricular distension, indicating high intraventricular pressures and compromised myocardial perfusion.[6,7] The aim of the present study is to evaluate an animal model for critical post-cardiotomy failure and VA-ECMOsupported circulation, focusing on the relationship between left ventricular distension, coronary circulation and myocardial perfusion early after aortic declamping
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