PMID- 23644613
OWN - NLM
STAT- MEDLINE
DCOM- 20131101
LR  - 20130506
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 59
IP  - 3
DP  - 2013 May-Jun
TI  - Flow modulation algorithms for intra-aortic rotary blood pumps to minimize 
      coronary steal.
PG  - 261-8
LID - 10.1097/MAT.0b013e31828fd6c8 [doi]
AB  - Intra-aortic rotary blood pumps (IARBPs) have been used for partial cardiac 
      support during cardiogenic shock, myocardial infarction, percutaneous coronary 
      intervention, and potentially viable for long-term circulatory support. 
      Intra-aortic rotary blood pump support continuously removes volume from the 
      aortic root, which lowers left ventricular preload, external work (LVEW), and 
      improves end-organ perfusion. However, IARBP support diminishes aortic root 
      pressure and coronary artery. It may also create "coronary steal," which may 
      produce a myocardial hypoxic state adversely affecting patient outcomes. Our 
      objective was to develop IARBP flow modulation algorithms to eliminate coronary 
      steal and improve the myocardial supply-demand ratio without compromising the 
      clinical benefits of restored end-organ perfusion and reduced LVEW. The 
      hemodynamic responses of the native ventricle, coronary, and systemic vasculature 
      to timing and synchronization of IARBP flow modulation (cyclic variation of pump 
      flow) were investigated using a clinical heart failure (HF) computer simulation 
      model. A total of more than 150 combinations of varying pulse widths and 
      time-shifts to modulate IARBP flow were tested at mean IARBP flow rates of 2, 3, 
      and 4 L/min, and compared with HF baseline values (no IARBP support). Increasing 
      IARBP support augmented cardiac output and diminished LVEW. Nonmodulated IARBP 
      support significantly diminished mean diastolic coronary flow (-49%) and 
      myocardial supply-demand ratio (-12%) compared with HF baseline. Intra-aortic 
      rotary blood pump flow modulation increased mean diastolic coronary flow (+17%) 
      and myocardial supply-demand ratio (+24%) compared with nonmodulated IARBP 
      (constant flow). Modulation and synchronization of IARBP support augmented 
      coronary artery perfusion and myocardial supply-demand ratio in simulated 
      clinical HF while also restoring end-organ perfusion and reducing LVEW. 
      Implementation of IARBP support with flow modulation may prevent myocardial 
      hypoxia and improve patient outcomes. However, even with flow modulation, IARBP 
      support provides a smaller improvement in myocardial supply demand ratio compared 
      to ventricular assist devices and intra-aortic balloon pumps.
FAU - Ising, Mickey S
AU  - Ising MS
AD  - School of Medicine, University of Louisville, Louisville, Kentucky, USA.
FAU - Koenig, Steven C
AU  - Koenig SC
FAU - Sobieski, Michael A
AU  - Sobieski MA
FAU - Slaughter, Mark S
AU  - Slaughter MS
FAU - Giridharan, Guruprasad A
AU  - Giridharan GA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Algorithms
MH  - Arterial Pressure/*physiology
MH  - Computer Simulation
MH  - Coronary Circulation/*physiology
MH  - Coronary Vessels/*physiology
MH  - Heart Failure/*physiopathology
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Intra-Aortic Balloon Pumping/*instrumentation
EDAT- 2013/05/07 06:00
MHDA- 2013/11/02 06:00
CRDT- 2013/05/07 06:00
PHST- 2013/05/07 06:00 [entrez]
PHST- 2013/05/07 06:00 [pubmed]
PHST- 2013/11/02 06:00 [medline]
AID - 00002480-201305000-00011 [pii]
AID - 10.1097/MAT.0b013e31828fd6c8 [doi]
PST - ppublish
SO  - ASAIO J. 2013 May-Jun;59(3):261-8. doi: 10.1097/MAT.0b013e31828fd6c8.