Negative Impact of Acute Reloading after Mechanical Left Ventricular Unloading

• DOI: 10.1007/s12265-023-10371-z
• Publication Date: 2023-04-06T13:05:29Z
• Authors: Renata Mazurek; Taro Kariya; Tomoki Sakata; Spyros A. Mavropo...; Anjali J. Ravicha...; Francisco J. Romeo; Kelly P. Yamada; Kiyotake Ishikawa

Mechanical LV unloading for acute myocardial infarction (MI) is a promising supportive therapy to reperfusion. However, no data is available on exit strategy. We evaluated hemodynamic and cellular effects of reloading after Impella-mediated LV unloading in Yorkshire pigs. First, we conducted an acute study in normal heart to observe effects of unloading and reloading independent of MI-induced ischemic effects. We then completed an MI study to investigate optimal exit strategy on one-week infarct size, no-reflow area, and LV function with different reloading speeds. Initial studies showed that acute reloading causes an immediate rise in end-diastolic wall stress followed by a significant increase in cardiomyocyte apoptosis. The MI study did not result in any statistically significant findings; however, numerically smaller average infarct size and no-reflow area in the gradual reloading group prompt further examination of reloading approach as an important clinically relevant consideration.