Fig. 8

Impact of ECPELLA on right and left ventricular PV loops on BVF with PH haemodynamics. Three conditions of MCS are shown: Impella alone (A), 2.0 mL/min of VA-ECMO with Impella (B), and 4.0 mL/min of VA-ECMO with Impella (C). Different conditions are represented by various colours (black line: Baseline, yellow: supported with Impella P2, red: Impella P6). In the BVF with PH under ECPELLA support, an increase in Impella support level widened the RV-PV loop but did not change RV-EDV compared to the BVF condition (protocol 2). Higher Impella support level strikingly minimised the LV-PV loop in each VA-ECMO flow condition. PV loop pressure–volume loop, BVF biventricular failure, PH pulmonary hypertension, MCS mechanical circulatory support, VA-ECMO veno-arterial extracorporeal membrane oxygenation, RVP right ventricular pressure, RVV right ventricular volume, LVP left ventricular pressure, LVV left ventricular volume