Renal circulation and cellular metabolism during left ventricular assisted circulation: comparison study of pulsatile and nonpulsatile assists.

We examined left ventricular assist during 6 h for an acute myocardial infarction model in pigs. The outflow cannula was placed in the ascending aorta and an inflow cannula in the left atrium. A pump (Pulsatile group: Zeon Medical and Nonpulsatile group: Nikkiso HPM-15) was connected to each cannula. Items measured were the regional blood flow of the cortex and the medulla in the kidney, renal arterial flow, arterial blood ketone body ratio (AKBR), lactate/pyruvic acid, BUN, creatinine and beta 2-microglobulin. After experimental study, the kidneys were removed, and a pathological study was performed. In the pulsatile assisted group, renal cortical blood flow increased but medulla blood flow decreased. On the other hand, in the nonpulsatile assisted group, both regional blood flows decreased. That means that in the pulsatile assisted group intrarenal redistribution improved, rather than in the nonpulsatile assisted group. The results of our study indicated that pulsatile assist produced superior circulation in the kidney, and the microcirculation on the cell level was superior as well in early treatment of acute left heart failure.

[1]  K. Nakata,et al.  Comparison studies of major organ microcirculations under pulsatile- and nonpulsatile-assisted circulations. , 2008, Artificial organs.

[2]  A. Wechsler,et al.  Comparison of nonpulsatile and pulsatile extracorporeal circulation on renal cortical blood flow. , 1980, The Annals of thoracic surgery.

[3]  A. Sezai.  Major Organ Microcirculation during Assisted Circulation-Comparitive Studies of Pulsatile and Nonpulsatile Assists , 1996 .

[4]  R. Dilley,et al.  The effects of pulseless perfusion on the distribution of renal cortical blood flow and on renin release. , 1976, Surgery.

[5]  T. Masuzawa,et al.  Acute phase responses of vasoactive hormones to non pulsatile systemic circulation. , 1995, ASAIO journal.

[6]  Y. Nosé,et al.  Horizons for Cardiac Prostheses , 1995 .

[7]  R. Zelis,et al.  Alterations in vasomotor tone in congestive heart failure. , 1982, Progress in cardiovascular diseases.

[8]  M. Shiono.  Pneumatic ventricular assist divice : Its problems and future trends , 1995 .

[9]  B. Zickmann,et al.  Effects of pulsatile and nonpulsatile perfusion mode during extracorporeal circulation--a comparative clinical study. , 1992, The Thoracic and cardiovascular surgeon.

[10]  J. H. Stein,et al.  Mechanism of the redistribution of renal cortical blood flow during hemorrhagic hypotension in the dog. , 1973, The Journal of clinical investigation.

[11]  R. Körfer,et al.  Effects of pulsatile perfusion on plasma catecholamine levels and hemodynamics during and after cardiac operations with cardiopulmonary bypass. , 1990, The Journal of thoracic and cardiovascular surgery.

[12]  O. Frazier.  New technologies in the treatment of severe cardiac failure: the Texas Heart Institute experience. , 1995, The Annals of thoracic surgery.

[13]  K. Nakata.  Effect of Pulsatile and Nonpulsatile Assist for Microcirculation in Major Organs after Cardiogenic Shock. , 1996 .

[14]  Curtis Jj.  Centrifugal mechanical assist for postcardiotomy ventricular failure. , 1994 .

[15]  H. Harasaki,et al.  Chronic nonpulsatile blood flow. III. Effects of pump flow rate on oxygen transport and utilization in chronic nonpulsatile biventricular bypass. , 1996, The Journal of thoracic and cardiovascular surgery.

[16]  P. Perier,et al.  Isolated cleft mitral valve: valve reconstruction techniques. , 1995, Annals of Thoracic Surgery.

[17]  T. Masuzawa,et al.  How does the sympathetic nervous system behave during non pulsatile circulation? , 1995, ASAIO journal (1992).

[18]  D. Pennington,et al.  Eight years' experience with bridging to cardiac transplantation. , 1994, The Journal of thoracic and cardiovascular surgery.

[19]  H Harasaki,et al.  Chronic nonpulsatile blood flow in an alive, awake animal 34-day survival. , 1980, Transactions - American Society for Artificial Internal Organs.

[20]  E E SELKURT,et al.  Effect of Pulse Pressure and Mean Arterial Pressure Modification on Renal Hemodynamics and Electrolyte and Water Excretion , 1951, Circulation.

[21]  R. Körfer,et al.  Mechanical circulatory support: The Bad Oeynhausen experience , 1995 .

[22]  Y. Abe.  Intrarenal blood flow distribution and autoregulation of renal blood flow and glomerular filtration rate. , 1971, Japanese circulation journal.

[23]  R W Stewart,et al.  Postcardiotomy centrifugal mechanical ventricular support. , 1992, The Annals of thoracic surgery.