Direct comparison of percutaneous circulatory support systems in specific hemodynamic conditions in a porcine model

Background - Several percutaneous circulatory support systems have been recently introduced into clinical practice for the treatment of cardiogenic shock or refractory nontolerated ventricular tachycardia, in support of high-risk catheter interventions and, occasionally, cardiopulmonary resuscitation. To date, however, a direct comparison of the available systems has not been performed. Methods and Results - Adult female pigs (weight 50-60 kg) were used throughout the experiment. Under deep anesthesia and mechanical ventilation, 3 percutaneous circulatory support systems were compared: (1) right atrium-aorta, extracorporeal membrane oxygenation (n=4); (2) left atrium-aorta, TandemHeart system (n=4); (3) left ventricle-aorta, Impella 2.5 system (n=4), and (4) left ventricle-aorta with norepinephrine at 0.1 μg/kg per minute (n=4). Hemodynamic efficacy (mean arterial pressure) was measured at 3 specific conditions: ventricular pacing at 200 and 300 beats per minute, and ventricular fibrillation. Although no or only nonsignificant differences were found among the systems at ventricular pacing of 200 and 300 beats per minute, under ventricular fibrillation, the right atrium-aorta system was significantly the most efficacious, followed by the left atrium-aorta system and the left ventricle-aorta system (P<0.001). However, the left ventricle-aorta system with norepinephrine still maintained mean arterial pressure comparable with the left atrium-aorta system. Conclusions - Differences were seen in the hemodynamic efficacy of available percutaneous circulatory support systems, particularly under the most severe hemodynamic condition, ventricular fibrillation.