Clinical Paper: Beyond Reperfusion by Jerry Curran

October 7, 2019

Acute Ventricular Unloading and Cardioprotection During MI

Jerry Curran PhD, Senior Scientist at Abiomed, discusses a paper he recently co-authored describing how acute ventricular unloading is fundamentally different from other clinical therapies for attenuating the impact of ischemic-reperfusion (I-R) injury in the setting of myocardial infarction. The paper, co-authored with Dr. Daniel Burkhoff and Dr. Robert Kloner, is titled “Beyond Reperfusion: Acute Ventricular Unloading and Cardioprotection During Myocardial Infarction” and was published in the April 2019 issue of Journal of Cardiovascular Translational Research.

Dr. Curran explains that I-R injury has several components—including lethal cell death, necrosis, arrhythmias, and microvascular perfusion injury—all of which combine to insult the heart after infarction. What makes unloading different from other therapies targeting these components, he emphasizes, is the “pleiotropic nature of unloading”, that is, the ability of unloading to address all the underlying pathologies simultaneously. "This pleiotropism is important because not any one single aspect is responsible wholly for the damage that is taken on by the patient's heart after infarction. So, you must address all of the underlying pathologies simultaneously in order to be fundamentally successful in treating this disease."

Dr. Curran explains how mechanical circulatory support with Impella® unloads the heart, which helps the heart recover from any damage from the myocardial infarction. He describes how heart cells start to die after MI and how it is important to protect cells from such ischemic injury to increase the chances of heart recovery. There are biochemical pathways intrinsic to the heart, he explains, that you can activate to induce cardioprotection. “These are the pathways that we are trying to exploit by using acute mechanical circulatory support through the Impella® to protect the heart from ischemic injury and death.”

This paper describes how Impella support can fundamentally change each aspect of I-R injury and how the pleiotropic effect will protect the heart post-MI and allow more successful patient recovery. The paper also presents data regarding the current heart failure epidemic and the link between new cases of heart failure and MI.

"So, we're looking at a brand-new frontier in medicine,” Dr. Curran concludes, “and how mechanical circulatory support by Impella and acute ventricular unloading might just be able to impact the heart failure epidemic that we're facing as a society."

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