A Novel Mechanical Circulatory Approach for Patients with Cardiogenic Shock in the Intensive Care Unit


  • Christoph Bara
  • Alireza Ghodsizad
  • Biswajit Kar
  • Igor D. Gregoric
  • Artur Lichtenberg
  • Axel Haverich
  • Matthias Karck
  • Arjang Ruhparwar




Background. The capacity of the heart to maintain cardiac output can be acutely impaired as a result of myocardial infarction, graft failure after transplantation, or other cardiac events. Medical therapy or the use of an intra-aortic balloon pump may be insuffcient to help the patient overcome acute cardiogenic shock. The set-up of mechanical assist devices such as extracorporeal membrane oxygenation or patient relocation into the operating room requires valuable time that is often not available. The aim of our study was to test whether a novel left ventricular assist device can be percutaneously implanted without fluoroscopy under echocardigraphic navigation in a preclinical model.

Methods. Pigs were subjected to percutaneous implantation of a novel left ventricular assist device under navigation of transesophageal echocardiography (TEE) without fluoroscopic support. Percutaneous puncture of the interatrial septum using a Brockenbrough needle and insertion of the afferent cannula into the femoral vein and its advance to the right atrium and through the interatrial septum into the left atrium was performed under echocardiographic control. The efferent cannula was inserted into the contralateral femoral artery using the Seldinger technique.

Results. In all animals, the percutaneous implantation of a left ventricular assist device was successful under only TEE navigation.

Conclusions. The ability to abstain from fluoroscopy and the feasibility of inserting the afferent cannula across the interatrial septum guided by TEE allows for application of this system in intensive care units, saving precious time as well as financial and human resources.


Barron HV, Every NR, Parsons LS, et al, for the Investigators in the National Registry of Myocardial Infarction. 2001. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction. Am Heart J 141:933-9.nBurkhoff D, Cohen H, Brunckhorst C, O'Neill WW, for the Tandem Heart Investigators Group. 2006. A randomized multicenter clinical study to evaluate the safety and efficacy of the Tandem Heart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 152:469.e1-8.nDeWood MA, Notske RN, Hensley GR, et al. 1980. Intraaortic balloon counterpulsation with and without reperfusion for myocardial infarction shock. Circulation 61:1105-12.nGoldstein DJ, Oz MC. 2000. Mechanical support for postcardiotomy cardiogenic shock. Semin Thorac Cardiovasc Surg 12:220-8.nHochman JS, Buller CE, Sleeper LA, et al. 2000. Cardiogenic shock complicating acute myocardial infarction. Etiologies, management and outcome: a report from the SHOCK trial registry. J Am Coll Cardiol 36:1063-70.nLiang KW, Fu YC, Lee WL, et al. 2006. Intra-cardiac echocardiography guided trans-septal puncture in patients with dilated left atrium undergoing percutaneous transvenous mitral commissurotomy. Int J Cardiol [Epub ahead of print].nMiller LW, Lietz K. 2006. Candidate selection for long-term left ventricular assist device therapy for refractory heart failure. J Heart Lung Transplant 25: 756-64.nThiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. 2001. Reversal of cardiogenic shock by percutaneous left atrial-tofemoral arterial bypass assistance. Circulation 104: 2917-22.nThiele H, Sick P, Boudriot E, et al. 2005. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 26: 1276-83.n



How to Cite

Bara, C., Ghodsizad, A., Kar, B., Gregoric, I. D., Lichtenberg, A., Haverich, A., Karck, M., & Ruhparwar, A. (2007). A Novel Mechanical Circulatory Approach for Patients with Cardiogenic Shock in the Intensive Care Unit. The Heart Surgery Forum, 10(2), E170-E172. https://doi.org/10.1532/HSF98.20061214




Most read articles by the same author(s)

1 2 3 > >>