Direct comparison of mechanical circulatory support devices in porcine model of acute myocardial infarction complicated by ventricular septal defect and cardiogenic shock.

An optimal strategy for mechanical circulatory support (MCS) in acute myocardial infarction (AMI) complicated by ventricular septal defect (VSD) and cardiogenic shock remains unclear. This study compared the hemodynamic effects of intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), and a micro-axial pump (mAP) in a porcine model of AMI with VSD. Hemodynamic parameters, including left ventricular end-diastolic pressure (LVEDP), mean arterial pressure (MAP), carotid flow (CAR), and VSD shunt flow, were assessed under baseline conditions and during device support. All devices improved systemic perfusion, as reflected by increases in MAP and CAR. IABP provided modest but significant improvements across all measured parameters compared to baseline. ECMO resulted in the greatest increase in MAP and CAR; however, this was accompanied by a substantial rise in VSD shunt flow. In contrast, mAP achieved significant improvements in all parameters while demonstrating the most pronounced reduction in LVEDP and VSD flow. These findings indicate that all devices improved key hemodynamic parameters (MAP and CAR), but to varying degrees. Each device had a distinct impact on LVEDP and VSD flow. These observations may assist in selecting the most appropriate therapeutic approach for AMI complicated by VSD and cardiogenic shock.