Editorial/review

A Comparative Evaluation of Pulmonary Artery Balloon Counterpulsation and a Centrifugal Flow Pump in an Experimental Model of Right Ventricular Infarction

Division of Surgery, Walter Reed Army Institute of Research (MGM, BW, GMG), Departments of Medicine (AJT) and Cardiovascular Surgery (FHE), Walter Reed Army Medical Center, Washington DC, and the Uniformed Services University of the Health Sciences (GMG), Bethesda, MD

^* Address correspondence to: Allen J. Taylor MD, Department of Medicine, Walter Reed Army Medical Center, Washington DC, 20307-5001.

Abstract

To compare the efficiency of pulmonary artery balloon counterpulsation and a centrifugal flow pump in reversing the hemodynamic consequences of acute right-sided heart failure, we employed both devices in 14 Yorkshire pigs in which right ventricular infarction was created via surgical ligation of branches of the right coronary artery. Pulmonary artery balloon counterpulsation improved some of the indicators of right heart failure, as manifested by significantly decreased right atrial pressure and increased mean systemic blood pressure. In contrast, the centrifugal flow pump consistently and significantly reversed all of the hemodynamic consequences of right ventricular infarction. In comparison to pulmonary artery balloon counterpulsation, the centrifugal flow pump resulted in lower right atrial pressures (p=0.020), lower mean pulmonary pressures (p<0.0001), increased left atrial pressures (p=0.026), increased cardiac output (p<0.0001), and increased mean systemic blood pressures (p<0.0001). Possible mechanisms to explain the superiority of the centrifugal flow pump include better hemodynamic unloading of the failing myocardium and independence from right ventricular output.