Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Konstam, MA; Czerska, B; Böhm, M; Oren, RM; Sadowski, J; Khanal, S; Abraham, WT; Wasler, A; Dahm, JB; Gavazzi, A; Gradinac, S; Legrand, V; Mohacsi, P; Poelzl, G; Radovancevic, B; Van Bakel, AB; Zile, MR; Cabuay, B; Bartus, K; Jansen, P.
Continuous aortic flow augmentation: a pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure.
Circulation. 2005; 112(20):3107-3114
Doi: 10.1161/CIRCULATIONAHA.105.555367
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- Wasler Andrae
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- Abstract:
- 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Aorta - physiopathology
- Blood Flow Velocity - physiopathology
- Coronary Angiography - methods
- Female - methods
- Heart Failure, Congestive - epidemiology
- Hemodynamic Processes - epidemiology
- Humans - epidemiology
- Inpatients - epidemiology
- Kidney Function Tests - epidemiology
- Male - epidemiology
- Middle Aged - epidemiology
- Muscle, Smooth, Vascular - physiopathology
- Pilot Projects - physiopathology
- Prevalence - physiopathology
- United States - epidemiology
- Find related publications in this database (Keywords)
- heart failure
- hemodynamics
- vasodilation
- nitric oxide
- heart-assist device