Background: Percutaneous mechanical circulatory support (MCS) may protect the myocardium and reduce the risk of major adverse events. Clinical data on left ventricular (LV) unloading by pneumatically driven percutaneous devices are currently scarce.
Hypothesis: The aim of this sstudy was to describe the unloading pattern produced by a pulsatile MCS on the LV.
Methods: An 80-year-old man with chronic obstructive pulmonary disease with ischaemic cardiomyopathy was admitted with acute coronary syndrome with pathological Q waves in the inferior leads. Trans-thoracic echocardiography evidenced infero-posterior akinesia with 30% ejection fraction.
Coronary angiography showed chronic total occlusion on the right coronary artery, 90% stenosis on the left main (LM), 90% on the left anterior descending (LAD) and 90% on the left circumflex (LCX) artery. The case was considered non-suitable for surgical revascularisation. MCS was indicated by heart team
consensus with PulseCath iVAC2L™ (PulseCath BV). Stents were deployed on the LCX, LAD and LM. Haemodynamic data were collected with pulmonary catheterisation and a conductance catheter in the LV.
Results: Under 1:1 and 1:3 assist, the level of support was 1.36 and 0.62 l/min, respectively. After activating the percutaneous ventricular assist device, the percutaneous ventricular loops were shifted to the left. The pressure–volume area (11,504.05 ± 383.36 versus 1,1251 ± 572 mmHg/ml) decreased, as did stroke work (6,598 ± 191 versus 5,931 ± 489 mmHg/ml).
Pressures and volumes decreased at end-systole (end-systolic pressure: 110.44 ± 2.39 versus 104.38 ± 3.66 mmHg; end-systolic volume: 115.50 ± 4.97 versus 111.25 ± 3.41 ml) and end-diastole (end-dystolic pressure: 28.12 ± 2.62 versus 24.77 ± 3.90 mmHg; end-dystolic volume: 193.25 ± 5.15 versus 186.23 ± 4.76 ml).
Contractility was mostly unchanged (end-systolic elastance: 1.19 ± 0.05 versus 1.00 ± 0.13 mmHg/ml; V100: 106.73 ± 6.00 versus 107.22 ± 4.75 ml; +dP/dtmax: 835.31 ± 29.90 versus 849.69 ± 48.37 mmHg/second), and also lusitropy (tau 41.50 ± 3.23 versus 41.50 ± 3.67 ms; beta 5.28 ± 0.88 versus 5.36 ± 1.70; V30 192.84 ± 9.44 versus 195.19 ± 11.62 ml). The afterload improved (effective arterial elastance 1.51 ± 0.07 versus 1.46 ± 0.10 mmHg/ml; end-systolic wall stress 110.62 ± 2.39 versus 104.54 ± 3.67 mmHg) as well.
Conclusion: MCS unloaded the LV and optimised the pressure–volume area, with positive effects also over the afterload. Further insights will be released in the PULsecath mechanicaL Support Evaluation (PULSE) trial (NCT03200990).