Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation. Issue 20 (21st October 2021)

• Record Type: Journal Article
• Authors: Kametani, Motoko; Yamada, Masahiro; Horibata, Yoko; Sakamoto, Tomohiro; Unoki, Takashi
• Is Part Of: Physiological reports. Volume 9:Issue 20(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-10-21
• Subjects: coronary artery -- ECPELLA -- LV uncoupling -- refractory cardiogenic shock; Physiology -- Periodicals; 571
• DOI: 10.14814/phy2.15084
• Languages: English
• ISSNs: 2051-817X

Abstract

Abstract: An emerging therapeutic modality, ECPELLA, which combines a transvalvular microaxial left ventricular (LV) assist device, Impella, and venoarterial membrane oxygenation (VA‐ECMO), has been applied for patients with refractory cardiogenic shock. During ECPELLA support, VA‐ECMO increases the LV load, whereas the Impella reduces the LV load. Studies reported that coronary perfusion is influenced by LV unloading conditions, and the effective degree of LV unloading to increase the coronary perfusion on ECPELLA support remains to be determined. Here, we reported a cardiogenic shock case whose coronary arterial flow was assessed by transesophageal echocardiography during ECPELLA support. The left anterior descending coronary artery (LAD) peak blood flow velocity and the velocity time integral (VTI) were not significantly increased when blood was ejected from the LV (partial LV unloading). When the LV blood ejection was completely bypassed by Impella confirmed by non‐pulsatile aortic pressure with significantly reduced LV pressure with no aortic valve opening (LV uncoupling: no blood ejection from the LV), both peak velocity and VTI of the LAD were markedly increased and the blood flow became continuous throughout the cardiac cycle. Our case suggests that the coronary arterial flow in the injured myocardium is sensitive to degrees of LV unloading on ECPELLA support. Abstract : Continuous coronary blood flow was observed when the left ventricle (LV) is uncoupled from the systemic circulation by Impella pump support where the LV pressure never exceeds the aortic pressure during the entire cardiac cycle.