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Ann Thorac Surg 1992;53:30-37
© 1992 The Society of Thoracic Surgeons

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Articles

Evaluation of an extraaortic counterpulsation device in severe cardiac failure

^a Cardiothoracic Research Laboratory, Division of Cardiothoracic Surgery, Department of Surgery, The New York Hospital-Cornell Medical Center, New York, New York, USA
^b Division of Artificial Organs, Department of Surgery, University of Utah, Salt Lake City, Utah, USA

^_* Address reprint requests to Dr Zelano, Cornell University Medical Center, 525 East 68th St, Box 378, New York, NY 10021.

A valveless, single-orifice polyurethane ventricle with a maximum stroke volume of 60 mL was implanted on the brachiocephalic artery just above the aortic arch in sheep (n = 14) to act as an extraaortic counterpulsation device. In parallel, an intraaortic balloon was placed in the descending thoracic aorta. Both devices were pneumatically driven with an intraaortic balloon pump console that was gated by the electrocardiogram to provide aortic diastolic augmentation at a stroke volume of 40 mL. To compare the efficacy of counterpulsation for each device during severe cardiac failure, biventricular block was induced by continuous infusion of esmolol (100 to 600 µg · kg^–1 · min^–1), titrated to reduce aortic flow and pressure to less than 75% of baseline. Pulsatile coronary and aortic flows were recorded with ultrasonic flow probes placed around their respective vessels. Aortic root and left ventricular pressures were recorded using micromanometers. The enhancement of hemodynamic variables for both devices were compared for optimal timing conditions, which were defined as inflation set just before the dicrotic notch and deflation bordering on isovolumetric systole. The extraaortic counterpulsation device was able to significantly augment aortic and coronary flows while simultaneously decreasing left ventricular tension time index and aortic end-diastolic pressure (p < 0.02). The intraarotic balloon pump was able to significantly reduce only tension time index (p < 0.002) to a lesser extent that the extraaortic counterpulsation device. All analysis was performed with the pairedsamples t test. The extraaortic counterpulsation device greatly improves the myocardial oxygen supply-consumption ratio of the left ventricle by increasing diastolic coronary flow and reducing left ventricular wall tension during systole. The salutary effects of the extraaortic counterpulsation device greatly exceed those of the intraaortic balloon pump, and it may, therefore, provide a viable alternative for patients in pump failure after cardiopulmonary bypass.

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