on November 7, 2005
Published online before print November 7, 2005, doi: 10.1161/CIRCULATIONAHA.105.555367
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Submitted on January 11, 2005
From Tufts-New England Medical Center and Tufts University (M.A.K.), Boston, Mass; Henry Ford Heart & Vascular Institute (B.C., S.K.), Detroit, Mich; University Hospital Saarland (M.B.), Homburg, Germany; University of Iowa (R.M.O., B.C.), Iowa City, Iowa; Jagiellonian University (J.S., K.B.), Krakow, Poland; The Ohio State University (W.T.A.), Columbus, Ohio; University Hospital Graz (A.W.), Graz, Austria; University Hospital (J.B.D.), Greifswald, Germany; Riuniti Hospital (A.G.), Bergamo, Italy; Dedinje Cardiovascular Institute (S.G.), Belgrade, Yugoslavia, Sart Tilman University Hospital (V.L.), Liege, Belgium; University Hospital Bern (P.M.), Bern, Switzerland, University Hospital Innsbruck (G.P.), Innsbruck, Austria; Texas Heart Institute at St. Luke’s Episcopal Hospital (B.R.), Houston, Tex; Medical University of South Carolina (A.B.V.B., M.R.Z.), Charleston, SC; and Orqis Medical (P.J.), Lake Forest, Calif. * To whom correspondence should be addressed. E-mail: MKonstam{at}tufts-nemc.org.
Background--Diminished aortic flow may induce adverse downstream vascular and renal signals. Investigations in a heart failure animal model have shown that continuous aortic flow augmentation (CAFA) achieves hemodynamic improvement and ventricular unloading, which suggests a novel therapeutic approach to patients with heart failure exacerbation that is inadequately responsive to medical therapy. Methods and Results--We studied 24 patients (12 in Europe and 12 in the United States) with heart failure exacerbation and persistent hemodynamic derangement despite intravenous diuretic and inotropic and/or vasodilator treatment. CAFA (mean±SD 1.34±0.12 L/min) was achieved through percutaneous (n=19) or surgical (n=5) insertion of the Cancion system, which consists of inflow and outflow cannulas and a magnetically levitated and driven centrifugal pump. Hemodynamic improvement was observed within 1 hour. Systemic vascular resistance decreased from 1413±453 to 1136±381 dyne · s · cm-5 at 72 hours (P=0.0008). Pulmonary capillary wedge pressure decreased from 28.5±4.9 to 19.8±7.0 mm Hg (P<0.0001), and cardiac index (excluding augmented aortic flow) increased from 1.97±0.44 to 2.27±0.43 L · min-1 · m-2 (P=0.0013). Serum creatinine trended downward during treatment (overall P=0.095). There were 8 complications during treatment, 7 of which were self-limited. Hemodynamics remained improved 24 hours after CAFA discontinuation. Conclusions--In patients with heart failure and persistent hemodynamic derangement despite intravenous inotropic and/or vasodilator therapy, CAFA improved hemodynamics, with a reduction in serum creatinine. CAFA represents a promising, novel mode of treatment for patients who are inadequately responsive to medical therapy. The clinical impact of the observed hemodynamic improvement is currently being explored in a prospective, randomized, controlled trial.
Revised on August 10, 2005
Accepted on August 11, 2005
Continuous Aortic Flow Augmentation. A Pilot Study of Hemodynamic and Renal Responses to a Novel Percutaneous Intervention in Decompensated Heart Failure
Marvin A. Konstam MD*,
Key words: heart failure • hemodynamics • vasodilation • nitric oxide • heart-assist device
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Circulation 2005 112: 3025.