Distinct Effects of Left or Right Atrial Cannulation on Left Ventricular Hemodynamics in a Swine Model of Acute Myocardial Injury

Esposito, Michele; Shah, Nimish; Dow, Sam; Kang, Sandra; Paruchuri, Vikram; Karas, Richard H.; Kapur, Navin K.

doi:10.1097/mat.0000000000000416

Cited by 20 publications

(12 citation statements)

References 17 publications

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“…Since VA-ECMO displaces venous blood into the arterial system, an oxygenator is placed in the circuit prior to the return of blood to the femoral artery. The distinct location of the inflow cannula has a profound impact on the hemodynamic effects of these two systems 23 . Since VA-ECMO drains blood from a large venous reservoir, at typical flow rates of 4 to 6 liters/minute, VA-ECMO does not significantly reduce LV volume.…”

Section: Solving the Hemodynamic Support Equation With Acute Mechanicmentioning

confidence: 99%

Acute mechanical circulatory support for cardiogenic shock: the “door to support” time

Esposito

Kapur

2017

F1000Res

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Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction. CS begins as a hemodynamic problem with impaired cardiac output leading to reduced systemic perfusion, increased residual volume within the left and right ventricles, and increased cardiac filling pressures. A critical step towards the development of future algorithms is a clear understanding of the treatment objectives for CS. In this review, we introduce the “door to support” time as an emerging target of therapy to improve outcomes associated with CS, define four key treatment objectives in the management of CS, discuss the importance of early hemodynamic assessment and appropriate selection of acute mechanical circulatory support (AMCS) devices for CS, and introduce a classification scheme that identifies subtypes of CS based on cardiac filling pressures.

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Section: Solving the Hemodynamic Support Equation With Acute Mechanicmentioning

confidence: 99%

Acute mechanical circulatory support for cardiogenic shock: the “door to support” time

Esposito

Kapur

2017

F1000Res

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“…Ventricular brillation is the most frequent side-effect of previous experimental cardiogenic shock models, leading to death in up to 50% of animals [16,17,21,27]. To reduce the loss of animals, antiarrhythmics were administered before ethanol injection, and this resulted in ventricular brillation in only one animal.…”

Section: Con Rming Site-speci C Injury: Electrophysiologymentioning

confidence: 99%

An innovative ovine model of severe cardiopulmonary failure supported by veno-arterial extracorporeal membrane oxygenation

Heinsar

Jung

Colombo

et al. 2021

Preprint

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Background Refractory cardiogenic shock (CS), frequently complicated by pulmonary failure, often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to sustain end-organ perfusion. Currently available animal models, such as the coronary ligation model, result in highly variable injury profiles and unacceptably high levels of subsequent ventricular fibrillation, cardiac arrest, and death. As the use of ECMO increases, there is a growing need for a clinically relevant, robust, and titratable model of severe cardiopulmonary failure supported by VA-ECMO. Methods Six sheep (60 ± 6 kg) were anaesthetized, intubated and mechanically ventilated. VA-ECMO was initially carried out at a flow rate of 1 L/min. CS was induced through 1-mL left ventricle myocardial injections of 96% ethanol and confirmed when systolic blood pressure (SBP) was < 90 mmHg and lactate > 4 mmol/L. Then, pulmonary failure was confirmed when PaO2 was < 60 mmHg through substantial decrease in the ventilatory support. Thereafter, VA-ECMO support was increased to obtain a mean arterial pressure of 65 mmHg. Echocardiography and cardiac Troponin I (cTnI) analysis were performed at baseline, upon CS confirmation, establishment of pulmonary failure and hourly thereafter. After 5h, the animals were euthanised and the heart collected for histological and macroscopic assessment. Results Ethanol (58 ± 23 mL) rapidly induced CS in all animals. cTnI levels increased near 5000-fold. SBP decreased from 97 ± 18 mmHg at baseline to 67 ± 14 mmHg upon CS, and lactate from 1.4 ± 0.8 to 4.7 ± 0.9 mmol/L, respectively. Echocardiography studies demonstrated a decrease in the left ventricular fractional area change from 34 ± 9% upon baseline to 16 ± 7% after CS. Analysis of myocardial tissue samples corroborated extensive cellular necrosis and inflammatory infiltrates. Conclusions We present a novel titratable model of severe cardiopulmonary failure in animal on VA-ECMO, through intramyocardial ethanol injections and reduction in ventilatory support. This model could be essential to further characterize left-sided heart failure and develop future treatments.

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“…The impact of TandemHeart on hemodynamics and cardiac morphology has been investigated in porcine models of acute MI or ventricular arrhythmia ( 151 , 152 , 153 , 154 , 155 ). For example, TandemHeart was implanted during LCx occlusion (30 min) and effectively unloaded the LV while maintaining systemic pressure, which was evident via decreased stroke volume, end-diastolic volume, and EDP ( 151 ). Impella devices have also been investigated in swine ( 152 , 156 , 157 , 158 , 159 , 160 , 161 ) and ovine ( 162 , 163 ) models of adult and pediatric HF.…”

Section: The Translational Role Of Large Animal Models Of Hf: a Critimentioning

confidence: 99%

Large Animal Models of Heart Failure

Silva

Emter

2020

JACC: Basic to Translational Science

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Highlights Preclinical large animal models play a critical and expanding role in translating basic science findings to the development and clinical approval of novel cardiovascular therapeutics. This state-of-the-art review outlines existing methodologies and physiological phenotypes of several HF models developed in large animals. A comprehensive list of porcine, ovine, and canine models of disease are presented, and the translational importance of these studies to clinical success is highlighted through a brief overview of recent devices approved by the FDA alongside associated clinical trials and preclinical animal reports. Increasing the use of large animal models of HF holds significant potential for identifying new mechanisms underlying this disease and providing valuable information regarding the safety and efficacy of new therapies, thus, improving physiological and economical translation of animal research to the successful treatment of human HF.

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Distinct Effects of Left or Right Atrial Cannulation on Left Ventricular Hemodynamics in a Swine Model of Acute Myocardial Injury

Cited by 20 publications

References 17 publications

Acute mechanical circulatory support for cardiogenic shock: the “door to support” time

Acute mechanical circulatory support for cardiogenic shock: the “door to support” time

An innovative ovine model of severe cardiopulmonary failure supported by veno-arterial extracorporeal membrane oxygenation

Large Animal Models of Heart Failure

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