Effects of synchronized cardiac assist device on cardiac energetics

Amir Landesberg, Avshalom Shenhav, Rona Shofty, Eugene Konyukhov, Carmit Levy, Oscar Lichtenstein, Rafael Beyar, Henk E D J Ter Keurs, Giora Landesberg, Marco Cabrera, William Stanley, Gerald M. Saidel

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

A novel physiological cardiac assist device (PCAD), the LEVRAM assist device, which is synchronized with the failing heart ejection, was developed to improve the failing heart systolic and diastolic functions and cardiac energetics. The PCAD uses a single short cannula, which is inserted into the beating left ventricle (LV) by means of a specially designed device. Blood is ejected from the PCAD into the LV after the opening of the aortic valve and augments the cardiac stroke work. The same amount of blood is withdrawn from the LV into the PCAD, through the same cannula, during the diastole. The study aims to test the effects of the PCAD on cardiac energetics and coronary blood flow. Adult normal sheep were anesthetized and the heart was exposed by left thoracotomy. Pressures transducers (Millar Instruments, Inc., Houston, TX) were inserted into the LV and aorta. LV volume was measured by sonocrystals (Sonometrics Corp., London, Ontario, Canada) and impedance catheter (CD Lycom, Argonstrat 116 Zoetermeer, 2718 SP The Netherlands). Flowmeters (transonic) measured the cardiac output (CO) and the coronary arteries (left anterior descending (LAD) and circumflex) flows. A thin cannula was inserted into the coronary sinus and the oxygen content of the LV and the coronary sinus were determined (AVOXimeter-1000). Pressure-volume loops, myocardial energetics, and coronary flow were measured. The displaced PCAD volume was 11 mL. Four different levels of assist were studied by changing the frequency of the assist: (1) assist beat after three successive regular beats [1:4], (2) assist every third beat [1:3], (3) alternate assist and normal beat [1:2], and (4) continuous assist [1:1]. Cardiac output (CO) and stroke volume (SV) increased proportionally with increasing frequency of assist. Systolic mechanical efficiency of the PCAD was above 90%. Simultaneously, the PCAD decreased the end-diastolic volume (EDV; diastolic unloading). The PCAD increased coronary flow and decreased cardiac arterial-venous O2 difference. We conclude that the PCAD efficiently augments CO and stroke work, decreases preload, and decreases the coronary arterial-venous O2 difference; all these may expedite cardiac reverse remodeling, and promote recovery of function and eventual easy explanation of the device.

Original languageEnglish (US)
Title of host publicationAnnals of the New York Academy of Sciences
Pages466-478
Number of pages13
Volume1080
DOIs
StatePublished - Oct 2006
Externally publishedYes

Publication series

NameAnnals of the New York Academy of Sciences
Volume1080
ISSN (Print)00778923
ISSN (Electronic)17496632

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Keywords

  • Cardiac mechanics
  • Coronary flow
  • Excitation-contraction coupling
  • Heart failure
  • Reverse remodeling
  • Ventricular assist device

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Landesberg, A., Shenhav, A., Shofty, R., Konyukhov, E., Levy, C., Lichtenstein, O., Beyar, R., Ter Keurs, H. E. D. J., Landesberg, G., Cabrera, M., Stanley, W., & Saidel, G. M. (2006). Effects of synchronized cardiac assist device on cardiac energetics. In Annals of the New York Academy of Sciences (Vol. 1080, pp. 466-478). (Annals of the New York Academy of Sciences; Vol. 1080). https://doi.org/10.1196/annals.1380.035