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The author, as a coordinating investigator, jointly with the other ten PIs conducted a 62-case multicenter clinical trial of a domestic HeartCon implantable left ventricular assist device(LVAD) for the treatment of end-stage heart failure(ESHF), the results of which demonstrated the safety and efficacy of the device. In the clinical practice, we have not only validated the international general knowledge, but also created some ideas and methods that are different from the international traditional practice and has been proved to be more reasonable by repeated practice. We hereby would like to share our experience and speculation, so as to provide the reference for the colleagues.
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By reporting the technical skill and the management tactics in the operation of the left ventricular assist device(LVAD) implantation, we provide our reference and experience for the colleagues in their clinical practice.
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Objective:To analyze and evaluate the safety and efficacy of a Chinese domestically manufactured Heart Con-type implantable third-generation magnetic and hydrodynamic levitation left ventricular assist device(LVAD) for the treatment of end-stage heart failure(ESHF), by reporting the results of eleven-center clinical trial on 50 cases.Methods:This study was a multicenter clinical trial, designed by means of prospective, multicenter and single-group target value. 50 subjects with ESHF were competitively enrolled and treated with HeartCon as the LVAD in eleven centers. The primary efficacy measure was survival, defined as either the subjects experiencing the transition to heart transplantation(HT) or myocardial recovery assisted by the device within 90 days, or as successfully assisted by the LVAD for full 90 days after implantation. The target survival rate was 60%, other observations included implantation success rate, mortality, pump failure needing replacement or emergency heart transplantation.Results:All enrolled 50 patients received LVAD implantation successfully, 46 survived with the pump for 90 days, 1 patient transitioned to heart transplantation, and 3 patients experienced pump thrombosis, within which 2 patients underwent pump replacement and continued to live with the pump for 90 days, and the other one received emergency heart transplantation. There were no dropout subjects. The survival rate at full 90 days after HeartCon implantation was 100%. The survival rates with pump in the full set analysis and the protocol set analysis were 96.00% and 95.92% respectively, which were higher than the target value of 60%. The differences were both statistically significant( P<0.05). Conclusion:The results of the multicenter clinical trial with the largest sample size in China using domestically manufactured third-generation LVAD has demonstrated that, HeartCon is a safe and effective LVAD to treat ESHF patients.
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Objective:To investigate and evaluate the efficacy of HeartCon left ventricular assist device (LVAD) in the treatment of adult patients with end-stage heart failure (ESHF).Methods:A prospective and observational study was conducted. Patients with ESHF who underwent LVAD implantation in the department of cardiac surgery of Teda International Cardiovascular Hospital from September 2020 to August 2021 were selected. The left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) classification, N-terminal pro-B type natriuretic peptide (NT-proBNP), and six minute walk distance (6MWD) before operation and 90 days after operation were compared. The incidence of equipment failures and major adverse events within 90 days after operation were recorded.Results:A total of 20 patients with ESHF were included, with 15 males and 5 females. Patients' age ranged from 20 to 67 years old, with an average of (50.2±13.6) years old. The range of body weight was 49.8-106.1 kg, with an average of (67.9±15.5) kg, and the body surface area (BSA) was from 1.49 to 2.32 m 2, with an average of (17.6±0.22) m 2. The operation process of all the patients were successful. The length of hospital stay ranged from 33 to 90 days, and the average was 56.0 (42.8, 75.0) days. Complications within 90 days after operation as follows, 2 cases with pericardial tamponade (10%), 1 case with cerebral hemorrhage (5%), 1 case with mediastinum infection (5%), 3 cases with acute renal injury (AKI, 15%), 5 cases with gastrointestinal bleeding (25%). There were no mechanical failure of LVAD and hemolysis events, right ventricular failure (RVF), cerebral infarction and death occurred. Compared with preoperative, the LVEDD significantly decreased (mm: 67.50±13.98 vs. 77.40±9.73), LVEF significantly increased (%: 34.80±9.76 vs. 22.70±5.62), NT-proBNP significantly decreased (ng/L: 2 028.65±1 752.05 vs. 4 796.45±4 355.40), 6MWD significantly increased (m: 385.20±144.12 vs. 85.81±63.50) at 90 days after operation, and the differences were statistically significant (all P < 0.05). 18 cases (90%) of the 20 patients reached NYHA classification Ⅰ and 2 cases (10%) reached NYHA classification Ⅱ, which were significantly improved compared with those before surgery (all patients' NYHA classification were Ⅳ before surgery). Conclusion:HeartCon LVAD can effectively improve the life quality of patients with ESHF, which has been proved safe and effective in clinical trials, but its long-term effects and complications need further observation and study.
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Objective:To evaluate the clinical value of intraoperative transesophageal echocardiography (TEE) in monitoring left ventricular assist device (LVAD) implantation.Methods:Between March 2019 and November 2021, 23 consecutive patients from TEDA International Cardiovascular Hospital, including 21 cases with dilated cardiomyopathy, 1 case with myocardial noncompaction and 1 case with ischemic cardiomyopathy, underwent HeartCon blood pump, a type of third generation LVAD implantation for severe heart failure. TEE was preformed in all cases before and after cardiopulmonary bypass. The dimensions of left-sided and right-sided cardiac chamber, ventricular function, de-airing, interventricular septal position, inlet cannulae position and the function of device were observed and recorded during LVAD implantation. Paired t test was used for statistical analysis of left-sided and right-sided heart parameters in pre- and post-operative measurements. Results:The left heart was dilated significantly and coexistent with right heart enlargement in some degree before LVAD implantation in total 23 cases. More than moderate mitral regurgitation (MR) in 16 cases and less than moderate MR in 7 cases were present. Mild or trace aortic regurgitation (AR) existed in 13 cases. More than moderate tricuspid regurgitation (TR) in 4 cases and less than moderate TR in 16 cases were observed. Left atrial appendage thrombosis was detected in 2 cases. After LVAD implantation, TEE revealed that the left ventricular end-diastolic diameter reduced significantly (42 mm/m 2 vs 32.8 mm/m 2, P<0.05) and left ventricular ejection fraction increased accordingly (22.2% vs 34.0%, P<0.05). There were no significant differences in right ventricular diameter and fractional area change between pre- and post-operative findings(all P>0.05). The ratio of left ventricular inner diameter to right ventricular inner diameter (2.09 vs 1.69, P<0.05) decreased in total 23 cases after LVAD implantation.Interventricular septal position became neutral position instead of pre-oprative rightward position. The severity of MR decreased in varying degrees in total 23 cases after LVAD implantation. All patients underwent tricuspid valvuloplasty with residual mild regurgitation in 8 cases. Conclusions:HeartCon blood pump can effectively unload the left ventricle with sufficient cardiac output in patients with severe congestive heart failure. TEE plays a major role in the clinical decision making during LVAD implantation, which can evaluate pre-operative cardiac abnormalities, intra-operative air embolism, inlet cannulae position, cannulas patency and cardiac function, especially blood volume status and the balance between double ventricles, which is critical for optimal functioning of the device.
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Objective:To determine the adverse effects of continuous circulatory support on liver and kidney function in experimental animals using left ventricular assist devices (LVAD).Methods:Six healthy experimental sheep were selected and implanted with HeartCon type LVAD. The liver and kidney indexes of experimental sheep before and 70 days after operation were detected, including urea (UREA), creatinine (CREA), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL), and the functional changes of liver and kidney were evaluated.Results:The preoperative levels of UREA, CREA, ALT, AST and TBIL in the six experimental sheep were (4.60±1.51) mmol/L, (94.80±23.10) μmol/L, (16.20±6.87) U/L, (82.60±17.33) U/L, and (0.52±0.25) μmol/L, respectively. Compared with the indexes before the LVAD implantation, there was no significant change in CREA levels in experimental sheep after the implantation (all P>0.05). After the implantation, the levels of UREA, ALT, AST and TBIL increased to varying degrees within 1 to 14 days after the implantation. At the end of the study, the levels of UREA, ALT, AST and TBIL have returned to the preoperative levels, and the differences were not statistically significant (all P>0.05). Conclusions:Within the 70 days of continuous circulatory support with HeartCon-type LVAD, no evidence of adverse effects of continuous flow LVAD on the liver and kidney function of experimental animals was found. HeartCon-type LVADs are able to provide adequate circulatory support to maintain proper end-organ function.
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@#Objective To explore the predictive value of myocardial vitality in the improvement of cardiac function after coronary artery bypass grafting (CABG) in patients with ischemic heart failure. Methods From December 8, 2015 to November 12, 2018, 46 patients with ischemic heart failure who underwent CABG operation alone were collected retrospectively. There were 41 males and 5 females with an average age of 60.4±8.0 years. The myocardial vitality and number of different types of myocardium were measured. The clinical data of patients in the left ventricular ejection fraction (LVEF) improvement group (≥5%) and non-improvement group (<5%) were compared and analyzed. The correlation between each index and LVEF improvement was analyzed by logistic multivariate regression analysis, and the boundary value of hibernating myocardium between LVEF improvement and non-improvement was obtained by receiver operating characteristic (ROC) curve. Results There were significant differences in the number of hibernating myocardium (15.0%±12.3% vs. 4.3%±4.5%, P=0.000), the number of normal myocardium (74.7%±13.7% vs. 82.4%±8.6%, P=0.027), and cardiac function classification (NYHA) development (−0.7±0.7 vs. −0.3±0.5, P=0.047) between the two groups, but there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that the number of hibernating myocardium was an independent factor affecting the improvement of LVEF after CABG in patients with ischemic heart failure (OR=1.366, 95%CI 1.033-1.807, P=0.029). The ROC curve showed that the threshold value, sensitivity and specificity of hibernating myocardium were 15.0%, 43.8% and 100.0%, respectively. Conclusion The percentage of hibernating myocardium to left ventricular wall area ≥15.0% can accurately predict the improvement of LVEF in patients with ischemic heart failure after CABG. Preoperative myocardial vitality assessment has important diagnostic value in predicting the improvement of cardiac function in patients with ischemic heart failure after simple CABG.
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Objective To evaluate the curative effect of transcatheter arterial chemoembolization (TACE)combined with Antike in the treatment of primary liver cancer. Methods The data of 72 patients with primary liver cancer(90 lesions in total)admitted to the First Affiliated Hospital of Hebei North University from August 2016 to December 2017 were retrospectively analyzed. All patients were divided into the observa-tion group(n = 36)and the control group(n = 36)according to the therapeutic schedule. The patients in the control group(40 foci)were treated with TACE only,and the patients in the observation group(50 foci)re-ceived TCAE treatment,oral Antike capsules were taken at the same time with the frequency of three times a day,two capsules each time,and six weeks were planned for one treatment cycle. A total of four cycles were completed. All patients underwent CT enhancement scans one week before TACE treatment and six months after treatment. According to Response Evaluation Criteria in Solid Tumors,complete remission and partial remission were deemed as effectivity. The imaging data of the change of tumor size,postoperative tumor residual,tumor capsule growth and new intrahepatic metastases were analyzed and used to evaluate the curative effect of patients in the two groups. Results After 6 months of treatment,there were 39 effective lesions in the observation group and 23 in the control group. The total effective rate of the observation group was higher than that of the control group(78. 0％ vs. 57. 5％ ),and the difference was statistically significant(χ2 = 4. 357,P = 0. 037). Twenty-three neoplastic capsule lesions were detected in the observation group and 9 in the control group. The detection rate of neoplastic capsule was higher in the observation group than that in the control group(46. 0％vs. 22. 5％ ),and the difference was statistically significant(χ2 = 5. 356,P = 0. 021). There were 27 residual tumors and 5 new intrahepatic metastases in the observation group,30 residual tumors and 13 new intrahepatic metastases in the control group. The residual tumor rate and neohepatic metastasis rate in the observation group were lower than those in the control group(54. 0％ vs. 75. 0％ ;13. 9％ vs. 36. 1％ ),and the differences were statistically significant(χ2 = 4. 220,P = 0. 040;χ2 = 4. 741,P = 0. 029). Conclusion TACE combined with Antike is safe and effective in the treatment of primary liver cancer. It can improve the total clinical effi-ciency,promote the growth of tumor capsule,and reduce the recurrence rate and metastasis rate of tumor. It is worthy of clinical application.
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Objective To introduce and analyze the status of tumor multidisciplinary team (MDT) model application in primary hospitals.Methods MDT discussion decision-making and implementation of Nanpi People's Hospital from June 2013 to July 2015 were retrospectively analyzed.Results A total of 251 cases were recruited into the MDT discussion.Among them,233 primarily diagnosed cases reached MDT decision-making and 159 cases took the decision,118 cases achieved the purpose (74.2％),41 cases failed (25.8％).Yet in 74 cases not following the decision,11 cases achieved the desired purpose (14.9％),while 63 cases didn't meet the desired purpose (85.1％),the difference was statistically significant (x2 =71.97,P ＜ 0.01).Ultrasound interventional biopsy,enhanced CT scan,CT guided puncture,intraoperative frozen section examination in malignant tumor patients had significantly increased after MDT applied,the difference was statistically significant (all P ＜ 0.05).The annual new rural cooperative medical system referral rate in malignant tumor patients dropped sharply (x2 =19.86,P ＜ 0.01) Conclusions Doctors and cancer patients can benefit from MDT diagnosis and treatment model,which is worth generalization.
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Objective The purpose of this study was to evaluate the hemodynamic effects of an extra-thoracic paraaortic counterpulsation device(ETPACD) with various capacities in an animal model with acute heart failure.Methods The acute heart failure model was successfully induced by snaring branch of anterior descending coronary artery in sheep(weighting 35-42 kg,n =8).The ETPACD is a single port,40 ml,60 ml and 80 ml stroke volume blood chamber designed to be connected to descending aorta through a valveless graft and placed extra-thorax.The hemodynamic indices of 40 ml,60 ml and 80 ml stroke volume were recorded respectively during counterpulsation assistance.Results 40 ml,60 ml and 80 ml ETPACD increased cardiac output 36.98％ (P =0.009),34.16％ (P =0.012) and 53.26％ (P =0.000) respectively,80 ml compared with 60 ml and 40 ml respectively P =0.001,P =0.005.And on diastolic mean aortic pressure 43.40％ (P =0.000)、63.20％ (P =0.000) and 78.76％ (P =0.000),80ml compared with 60ml and 40ml respectively P =0.329,P =0.025.The ETPACD (40 ml,60 ml and 80 ml) increased left carotid artery flow 45.19％ (P =0.007) 、61.51％ (P =0.001) and 81.50％(P=0.000),80 ml compared with 60ml and40 ml respectively P=0.016,P =0.000.Conclusion This study demonstrated that ETPACD (40 ml,60 ml and 80 ml) provided benefit of circulatory support in acute heart failure with better effect on hemodynamic parameters provided by 80 ml.Therefore,ETPACD with larger stroke volume may become a promising counterpulsation device for treatment of heart failure.
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Cholangiocarcinoma is a malignant tumor that occurs in the bile duct epithelium,it is the second most common malignant tumor of the liver and bile duct after hepatocellular carcinoma.Imaging examination is an important method to detect bile duct cancer;the purpose of imaging is to determine the location of the tumor,and the extent of invasion and distant metastasis.Different imaging methods have their advantages and disadvantages,so they should be chosen based on the condition of patients,or be optimized as the combined detection.
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This paper is aimed to investigate the effect of fluid shear stress on the tight junction of laryngeal squamous carcinoma (Hep2) cells and to explore the potential molecular mechanism. Hep2 cells were selected and subjected to the fluid shear stress of 1.4 dyn/cm2 for different time, respectively. The morphological changes of Hep2 cells under shear stress were observed using inverted microscope. The cell-cell junctions were examined by transmission electron microscope (TEM). The expressions of tight junction proteins (including Occludin, Claudin-5 and ZO-1) and the distribution of Claudin-5 were examined by Western blot assay and laser scanning confocal microscope, respectively. The results indicated that Hep2 cells turned to spindle-like shapes after exposed to shear stress, and showed the trend of the recovering to original shapes when the shear stress was cancelled. The cell-cell junctions were tight under the shear flow condition, and the permeability was reduced under the condition of 1.4 dyn/cm shear flow. The expressions of tight junction proteins were enhanced with increased duration of shear flow, but reduced after removing shear flow. The result of Claudin-5 expression by immufluorescence assay was consistent with that by Western blot. The Claudin-5 mainly distributed in the cytoplasm under static condition, while it located at the intercellular after shear flow stimulation, and it appeared intercellular and cytoplasm after stopping shear flow stimulation. Therefore, it can be concluded that shear stress changes the morphology of laryngeal squamous carcinoma Hep2 cells, and upregulates the tight junction.
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Humans , Blotting, Western , Carcinoma, Squamous Cell , Pathology , Claudin-5 , Metabolism , Hep G2 Cells , Laryngeal Neoplasms , Pathology , Occludin , Metabolism , Stress, Mechanical , Tight Junctions , Zonula Occludens-1 Protein , MetabolismABSTRACT
Objective To analyze the clinical feature of thalassemia with pulmonary hypertension and investigate the influence of pulmonary hypertension on thalassemia.Methods From June 2007 to July 2011,clinical data of 19 patients with thalassemia complicated with pulmonary hypertension in TEDA International Cardiovascular Hospital of Tianjin Medical University and Affilated Hospital of Guilin Medical College were analyzed retrospectively.Twenty-two cases of thalassemia without pulmonary hypertension were as a control group,and follow-up time was set as 4 months to 24 months.Observed indicators included age,hemoglobin(Hb),lactate dehydrogenase (LDH),serum ferritin (SF),tricuspid regurgitation velocity (TRV) and left ventricular ejection fraction (LVEF).Results SF and TRV of the case group[(693.6 ± 234.6)μg/L and (2.6 ± 0.1)m/s] were significantly higher than those of the control [(209.5 ± 100.1) μg/L and (2.1 ± 0.3)m/s,all P ＜ 0.05]; but the differences between case and control group in Hb[(90.8 ± 10.7)g/L vs (89.3 ± 10.5)g/L],LDH[(320.9 ± 103.7)U/L vs (355.8 ± 140.3)U/L] and LVEF[(66.2 ± 7.1)％ vs (64.2 ± 4.7)％] were not statistically significant (all P ＞ 0.05).Logrank analysis showed that the prognosis was poor in patients with thalassemia complicated with pulmonary hypertension (x2 =4.95,P ＜ 0.05).Multiple regression analysis indicated that age and serum ferritin remained as predisposing risk factors for tricuspid regurgitation velocity,and serum ferritin had a greater impact on the velocity.Conclusion In patients with thalassemia complicated with pulmonary hypertension,the prognosis is poor; age and SF may be factors involved in the development of pulmonary hypertension.
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Objective Biodegradable polycaprolactone (PCL)/poly D,L-lactic/glycolic acid (PLGA) scaffold is a promising modality for diffuse coronary atherosclerosis diseases unavailable to bypass graft.The purpose of this study was to evaluate the long-term performance of PCL/PLGA scaffold in vivo following polymer degradation.Methods Two scaffolds with and without heparin modification [Heparinized Scaffold (HS) and Blank Scaffold (BS)] were implanted.Except for control group,bone marrow mesenchymal stem cells (MSCs) were also transplanted around the scaffold.Animals were grouped into control BS group,BS-MSCs group and HS-MSCs group (each n =6) and survived 6 months.Patency and integrity of scaffold were evaluated by echocardiography and 3D-DOCTOR software.Endothelium coverage of the lumen was evaluated by scanning electron microscopy.Neovessles and collagen fiber within the scaffold were identified by histological staining.Prostacyclin (PGI2) and thromboxane (TXA2) production in the plasma were measured by ELISA.The expression of cyclooxygenase (COX-1,COX-2) and prostacyclin synthase PGIS was detected by Western blot.Results The heparinized scaffold kept patent up to 6 months and the lumen was covered by confluent endothelial cells.Histological staining revealed remodeling of collagen fiber and reconstruction of neovascular network immediately around the lumen.PGI2 production and PGIS expression in BSMSCs group and HS-MSCs group significantly increased compared with BS group (P ＜ 0.05 and P ＜ 0.01,respectively).Nonetheless,TXA2 production and COX-1 expression in BS-MSCs group was more pronounced than HS-MSCs group (P ＜ 0.01),showing no difference between BS-MSCs and BS group (P ＞ 0.05).Conclusion Despite polymer degradation and entire heparin release,the scaffold could continuously keep the structual integrity and lumen patency until 6 months by reinforcement of host collagen fiber and PGI2 expression.
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BACKGROUND:Effects of different oxygen partial pressures on cytokine secretion of human adipose-derived stem cells have been differently reported. These differences may be caused by varying oxygen partial pressures. OBJECTIVE:To investigate the influence of different oxygen partial pressures on cytokines secreted from human adipose-derived stem cells. METHODS:Human adipose-derived stem cells were cultured in vitro and identified by its immunophenotype. Human adipose-derived stem cells were divided into five groups and cultured under different oxygen partial pressure conditions (1%, 3%, 5%, 10%, 21%) for 24 hours, respectively. With quantitative real-time PCR and enzyme linked immunosorbent assay, the secretion of cytokines, vascular endothelial growth factor, hepatocyte growth factor, nerve growth factor, keratinocyte growth factor, from human adipose-derived stem cells were analyzed on the gene and protein levels. RESULTS AND CONCLUSION:Human adipose-derived stem cells were positive for CD71, CD73, CD90, CD105 and negative for CD34, CD45, CD54, HLA-DR. From the aspect of gene level, hypoxia (1%, 3%O 2 ) promoted the expression of vascular endothelial growth factor and nerve growth factor from human adipose-derived stem cells (P0.05). Based on the protein level, protein secretion of hepatocyte growth factor and vascular endothelial growth factor from human adipose-derived stem cells was increased under hypoxia (P<0.01), but no changes occurred in nerve growth factor and keratinocyte growth factor. After cultured under hypoxic environment, human adipose-derived stem cells were promoted to express gene vascular endothelial growth factor, hepatocyte growth factor and nerve growth factor, as wel as to secrete protein keratinocyte growth factor and vascular endothelial growth factor.
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10.3969/j.issn.2095-4344.2013.23.020
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We report a 45 year-old Chinese woman with tetralogy of fallot that had two aortopulmonary collateral arteries and tricuspid regurgitation. Collateral circulation was blocked and total correction was successfully performed in our "one-stop" hybrid operation room. The patient was weaned from cardiopulmonary bypass after 97 minutes and was transferred to the intensive care unit for about 36 hours. Without any complications, the patient was discharged home in the following eight days
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MicroRNA (miRNA),a type of 22-25nt non-coding RNA,plays an important role in proliferation and apoptosis of the cardiomyocyte,as well as the pathogenesis of some common cardiovascular diseases.Recently,researches on circulating miRNA in cardiovascular disease draw more attentions.This review will focus on the application value of miRNA in cardiovascular disease,the characteristics of miRNA and its detection technology will be described as well.
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Objective To investigate the effects of adenosine supplementing cold blood cardioplegia on myocardial injury in patients undergoing milral valve replacement(MVR).Methods Thirty ASA Ⅱ or Ⅲ patients aged 18-64 yr with a BMI of 18-24 kg/m2 undergoing elective MVR were randomly divided into 2 groups(n =15each):control group(C)and adenosine group(A).In group A myocardial arrest was produced by infusing adenosine 6 mg diluted in normal saline 20 ml through aortic root after aorta was cross-clamped followed by cold blood cardiaplegic solution 20 mg/kg.In group C asystole was produced with cold blood cardioplegic solution 20 ml/kg alone every 30 min.Blood samples were taken from central vein at 5 min before(T1)and 4 h after aortic crossclamping(T2)and 24 h after operation(T3)for determination of plasma cardiac troponin Ⅰ(cTnI)concentration and creatine kinase-MB(CK-MB)activity.The amount of cardioplegic solution infused,cardiac arrest induction time(from infusion of adenosine or cardioplegic solution to asystole shown by ECG),restoration of spontaneous heartbeat,the amount of dopamine administered during the 2 h after CPB and aortic cross-clamping time were recorded.Results Supplementation of cold blood cardioplegia with adenosine significantly reduced cardiac arrest induction time,the total amount of dopamine administered during the 2 h after CPB and plasma cTnl concentration and CK-MB activity in group A compared with group C.Conclusion Cold blood cardioplegia supplemented with adenosine can attenuate myocardial injury in patients undergoing MVR.
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ObjectiveAn out-thoracic paraaortic counterpulsation device(PACD) developed in the Reseach Center of our hospital was evaluated for its hemodynamic effects in an animal model with induced acute heart failure.MethodsEight healthy adult sheep with a weight of 38.5 to 54.5 kg were used as models for acute heart failure by snaring branches of coronary arteries.Thoracotomy was performed through the space under the left 4th rib.A Satinski clamp was used for partially clamping the descending aorta, and the Dacron vascular graft of out-thoracic PACD was sutured end-to-side to the descending aorta.The out-thoracic PACD used in this study had a blood chamber that was separated from the gas chamber by a movable polyurethane membrane .A stroke volume of 60 ml could be pumped when it was fully inflated.A 4F multipurpose catheter was inserted through the left ventricular apex for measuring and recording left ventricular pressures.A standard 40-ml intraaortic balloon was inserted into the descending aorta via the surgically exposed left femoral artery.Baseline hemodynamic data were collected after the model for acute heart failure was created without mechanical support.Mechanical support was randomly initiated either by the IABP or by the out-thoracic PACD in each experimental phase.Both devices were driven by the same console and synchronization with electrocardiogram was performed.Hemodynamic indexes and left carotid artery flow were calculated at baseline (device off) and during the period of 1 : 2 support for the 60-ml out-thoracic PACD and 40-ml IABP in the same animal.Baseline and support modes for devices were maintained for 15 minutes individually to ensure that a steady-state was achieved.ResultsBoth out-thoracic PACD and IABP resulted in a increase in the cardiac output (17.79％ with out-thoracic PACD vs.13.46％ with IABP, P =0.803) and the mean diastolic aortic pressure (29.48％ with out-thoracic PACD vs.15.01％ with IABP, P = 0.001).The use of out-thoracic PACD also led to a greater reduction in left ventricular end-diastolic pressure (35.09％ with out-thoracic PACD vs.15.79％ with IABP, P = 0.004).Meanwhile the out-thoracic PACD increased left carotid artery flow (14.52％ with out-thoracic PACD vs.6.70％ with IABP, P =0.006).No evidence of hemolysis, thrombus formation or major organ injury was identified during the experiment.ConclusionThe study indicated that a 60-ml out-thoracic PACD, which providing an improved mechanical circulatory support, was superior to a 40-ml IABP in the setting of experimental acute heart failure.This device may be used as a desirable alternative for the long-term mechanical support in patients with severe heart failure or those waiting for a heart transplantation, owing to its properties of low cost,easily to be implanted and removed, as well as a high biocompatibility.