Abstract 15860: Arterial and Cardiac Hemodynamics in Advanced HF Patients Implanted With the C-Pulse Counterpulsation Device: Implications for Myocardial Recovery
Introduction: Despite intensive medical and device therapy, many HF patients remain symptomatic with refractory NYHA class III/IV. Therapeutic options are limited in this population, with the goal being stabilization of HF progression. A novel approach is the use of an extra-aortic counterpulsation device, C-Pulse™, consisting of an extra-vascular balloon cuff wrapped around the ascending aorta. The C-Pulse operates on principle of counterpulsation however placement on the proximal aorta may afford unique hemodynamic advantages over traditional counterpulsation devices. We report for the first time hemodynamic effects from advanced HF patients implanted with C-Pulse.
Methods: Radial tonometry and office BP were measured in successive patients (N=6) NYHA Class III/IV, 5M, EF 17.2±6.6%, age 67.8±9.7 years (mean±SD), during device optimization. Median time from implant was 180 days (range 1-1356 days). Waveforms and blood pressure were obtained after 5 minute steady state OFF period followed by device optimization (ON).
Results: Systolic and diastolic BP were maintained with optimization (Table). Myocardial perfusion indexed by subendocardial viability ratio (SEVR) significantly increased primarily resulting from increase in diastolic area, Ad. Cardiac ejection was enhanced; increased forward wave amplitude, P1, and reduced time to peak pressure, P2. Late systolic load from wave reflections was also reduced assessed by augmentation index (Aix).
Conclusions: In this small cohort, C-Pulse increased myocardial perfusion and reduced early and late components of cardiac load. Novel finding of reduced Aix may arise from aortic arch baroreceptor stimulation due to enhanced pulsatility or mechanical deformation from the balloon. These changes may translate into improved heart failure symptoms, cardiac reverse remodeling and possibly recovery.Further studies are needed to assess these mechanisms and their association with regression of heart failure.
Author Disclosures: J. Rame: None. D. Georgakopoulos: Employment; Significant; Sunshine Heart. D. Pomfret: Employment; Significant; Sunshine Heart. P. Atluri: None. P. Wiegn: None. P. Segers: Other Research Support; Modest; Sunshine Heart. W.T. Abraham: Honoraria; Significant; Sunshine Heart. Consultant/Advisory Board; Significant; Sunshine Heart.
- © 2015 by American Heart Association, Inc.