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Salutary Effects of the PULVAD, a Novel Implantable Counterpulsation Assist Device, on Cardiac Mechanoenergetics

Kontogiannis, Christos*; Aravantinos, Dionysios*; Nanas, Ioannis*; Kapelios, Chris J.*; Marinakis, Sotirios*; Vakrou, Styliani*; Sarchosi, Smaragdi*; Perrea, Despina N.; Mason, Jay W.; Nanas, John N.*; Malliaras, Konstantinos*

doi: 10.1097/MAT.0000000000000838
Adult Circulatory Support

The Pressure Unloading Left Ventricular Assist Vevice (PULVAD) is a novel implantable counterpulsation LVAD, designed to provide ventricular unloading with augmentation of LV performance and retention of pulsatility. We assessed the effects of the PULVAD on hemodynamics and LV mechanoenergetics in seven farm pigs with acute ischemic heart failure. The PULVAD was implanted in the thorax and was connected to the ascending aorta. The PULVAD was pneumatically driven by a standard intra-aortic balloon pump console and was electrocardiogram-synchronized to provide LV pressure unloading along with diastolic aortic pressure augmentation. Hemodynamics, indices of LV mechanoenergetics, and coronary blood flow were measured without and after brief PULVAD support. PULVAD support decreased LV afterload and improved LV mechanical performance (increased ejection fraction, stroke volume, cardiac output and maximum elastance). The PULVAD concurrently reduced LV energy consumption (decreased stroke work and pressure–volume area) and optimized LV energetic performance (improved the ratio of stroke work to pressure–volume area). PULVAD support increased mean coronary blood flow, through dramatic augmentation of diastolic blood flow. In conclusion, the PULVAD unloads the failing LV, optimizes LV mechanoenergetics, and augments coronary blood flow. These salutary effects of short-term PULVAD support provide the foundation for long-term testing.

From the *3rd Department of Cardiology, University of Athens School of Medicine, Athens, Greece

Laboratory for Experimental Surgery and Surgical Research “N.S. Christeas,” University of Athens School of Medicine, Athens, Greece

Division of Cardiology, University of Utah, Salt Lake City, Utah.

Submitted for consideration January 2018; accepted for publication in revised form May 2018.

Disclosure: John N. Nanas and Jay W. Mason are founders and equity holders in Kardiatec SA, a biomedical device manufacturer. Kardiatec SA provided the PULVAD devices used in the study. Kardiatec SA was not involved in study design, study execution, data analysis and interpretation, and drafting of this manuscript. The remaining authors report no relevant conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

The first two authors contributed equally to this study.

Correspondence: Konstantinos Malliaras, 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527, Athens, Greece. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs