Key result
Pulsatile VAD improves splanchnic blood flow and hepatic metabolism versus nonpulsatile VAD in cardiogenic shock.
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In these comparison studies, we examined changes in major organ microcirculations during circulatory support using pulsatile and nonpulsatile pumps. Acute myocardial infarction was created by left anterior descending (LAD) branch ligation. After the animals in these studies fell into cardiogenic shock, they were supported by mechanical assist devices: a pulsatile ventricular assist device (VAD) in 4 pigs, a nonpulsatile VAD in 4 pigs, and an intraaortic balloon pumping (IABP) plus nonpulsatile VAD in 4 pigs. Each group was supported for 3 h with an identical mean aortic pressure being maintained. As for parameters, the stomach mucosa, liver regional blood flow, stomach mucosal pH, and arterial blood keton body ratio (AKBR) were measured. Both regional blood flow and AKBR increased in the pulsatile group as compared with the nonpulsatile group. There were no differences in the stomach mucosal pH among the 3 groups. These results suggest that pulsatile assist rather than the nonpulsatile assist plays a significant role in the recovery of deteriorated splanchnic organs due to cardiogenic shock.
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Sezai et al. (1996) studied Cardiogenic shock secondary to acute myocardial infarction (porcine model) (n=12). Pulsatile ventricular assist device (VAD) or intraaortic balloon pumping (IABP) plus nonpulsatile VAD vs. Nonpulsatile ventricular assist device (VAD) was evaluated on Stomach mucosa and liver regional blood flow, stomach mucosal pH, and arterial blood ketone body ratio (AKBR). Pulsatile VAD support increased splanchnic regional blood flow and arterial blood ketone body ratio compared with nonpulsatile VAD over 3 hours in 12 pigs with cardiogenic shock.
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