Effects Of Intra-aortic Balloon Pump Research Articles

Angiopoietin-2 in acute myocardial infarction complicated by cardiogenic shock--a biomarker substudy of the IABP-SHOCK II-Trial.

Angiopoietin-2 (Ang-2) is a mediator of capillary leakage, and increased Ang-2 levels were associated with poor in-hospital outcome in a pilot study in cardiogenic shock (CS). In this larger study, we followed this hypothesis and aimed at assessing the predictive role of Ang-2 on short- and long-term mortality, investigating the effect of intra-aortic balloon pump (IABP) treatment on Ang-2 levels, and identifying clinical and procedural predictors of increased Ang-2. In the IABP-SHOCK II-trial, 600 patients with CS complicating acute myocardial infarction were assigned to therapy with or without IABP. This substudy included 189 randomized patients with serial blood sampling performed at days 1, 2, and 3. No significant differences in Ang-2 levels were found between patients with or without IABP. The Ang-2 levels above the median at day 1 were associated with 30-day [hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.26-3.10, P = 0.002) and 1-year mortality (HR 2.21, 95% CI 1.49-3.27, P < 0.001). Stratification of patients according to Ang-2 levels at day 3 increased these associations (30 days HR 5.15, 95% CI 2.80-9.45, P < 0.001; 1 year HR 5.24, 95% CI 3.19-8.58, P < 0.001). The Ang-2 concentrations were independent predictors for mortality in multivariate analysis (30 days HR 4.82, 95% CI 1.52-15.23, P = 0.007; 1 year HR 2.01, 95%CI 1.24-3.24, P = 0.005). Predictors of increased Ang-2 levels at day 3 were baseline Ang-2, development of acute kidney injury, bleeding events or transfusion, and impaired reperfusion. In CS, high levels of Ang-2 are independently associated with poor short- and long-term outcome and associated with the reperfusion success as well as complications. URL: www.clinicaltrials.gov; unique identifier: NCT00491036.

Effect of intra-aortic balloon pump on coronary blood flow during different balloon cycles support: A computer study.

Intra-aortic balloon pump (IABP) has been used in clinical treatment as a mechanical circulatory support device for patients with heart failure. A computer model is used to study the effect on coronary blood flow (CBF) with different balloon cycles under both normal and pathological conditions. The model of cardiovascular and IABP is developed by using MATLAB SIMULINK. The effect on coronary blood flow has been studied under both normal and pathological conditions using different balloon cycles (balloon off; 1:4; 1:2; 1:1). A pathological heart is implemented by reducing the left ventricular contractility. The result of this study shows that the rate of balloon cycles is related to the level of coronary blood flow.

Clinical outcomes of the intra-aortic balloon pump for resuscitated patients with acute myocardial infarction complicated by cardiac arrest

BackgroundThe aim of this study was to investigate the clinical effects of intra-aortic balloon pump (IABP) in patients who received cardiopulmonary resuscitation (CPR) before procedure. Methods and resultsBetween November 2005 and April 2014, 49,542 patients were enrolled in a prospective cohort study for acute myocardial infarction (AMI) in Korea (KAMIR). CPR was performed in 1700 patients with cardiac arrest. Patients were excluded from the study if they had not undergone a coronary angiogram, if extracorporeal membrane oxygenation or thrombolysis was performed, and if mechanical complications presented. The primary end point was 1-month all-cause mortality. A total of 883 patients in the IABP group and 476 in the control group were included. During the 1-month follow-up, all-cause death occurred in 749 patients (55.1%). The IABP group was predominantly male and had a higher prevalence of ST-segment elevation MI and a higher risk of coronary lesions including left main disease and three-vessel disease. Glycoprotein IIb/IIIa inhibitor was administered less in the non-IABP group. In the total population, the IABP group had worse outcomes in terms of mortality rates after multivariate analysis [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.02–1.47, p=0.034] without increasing the incidence of recurrent MI, stroke, and major bleeding. After propensity matching with a pair of 452 patients, no significant differences were observed in baseline characteristics or clinical outcomes (HR 1.21, 95% CI 0.93–1.57, p=0.158). ConclusionThe use of IABP did not show clinical benefits in patients with AMI complicated by severe cardiogenic shock after propensity matching analysis.

Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

BackgroundThe use of aortic counterpulsation therapy in advanced heart failure is controversial.ObjectivesTo evaluate the hemodynamic and metabolic effects of intra-aortic balloon pump (IABP) and its impact on 30-day mortality in patients with heart failure.MethodsHistorical prospective, unicentric study to evaluate all patients treated with IABP betwen August/2008 and July/2013, included in an institutional registry named TBRIDGE (The Brazilian Registry of Intra-aortic balloon pump in Decompensated heart failure - Global Evaluation). We analyzed changes in oxygen central venous saturation (ScvO2), arterial lactate, and use of vasoactive drugs at 48 hours after IABP insertion. The 30-day mortality was estimated by the Kaplan-Meier method and diferences in subgroups were evaluated by the Log-rank test.ResultsA total of 223 patients (mean age 49 ± 14 years) were included. Mean left ventricle ejection fraction was 24 ± 10%, and 30% of patients had Chagas disease. Compared with pre-IABP insertion, we observed an increase in ScvO2 (50.5% vs. 65.5%, p < 0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and a decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and use of vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion. Thirty-day survival was 69%, with lower mortality in Chagas disease patients compared without the disease (p = 0.008).ConclusionAfter 48 hours of use, IABP promoted changes in the use of vasoactive drugs, improved tissue perfusion. Chagas etiology was associated with lower 30-day mortality. Aortic counterpulsation therapy is an effective method of circulatory support for patients waiting for heart transplantation.

Effects of intra-aortic balloon pump counterpulsation on left ventricular mechanoenergetics in a porcine model of acute ischemic heart failure.

We investigated the effects of intra-aortic balloon pump (IABP) counterpulsation on left ventricular (LV) contractility, relaxation, and energy consumption and probed the underlying physiologic mechanisms in 12 farm pigs, using an ischemia-reperfusion model of acute heart failure. During both ischemia and reperfusion, IABP support unloaded the LV, decreased LV energy consumption (pressure-volume area, stroke work), and concurrently improved LV mechanical performance (ejection fraction, stroke volume, cardiac output). During reperfusion exclusively, IABP also improved LV relaxation (tau) and contractility (Emax, PRSW). The beneficial effects of IABP support on LV relaxation and contractility correlated with IABP-induced augmentation of coronary blood flow. In conclusion, we find that during both ischemia and reperfusion, IABP support optimizes LV energetic performance (decreases energy consumption and concurrently improves mechanical performance) by LV unloading. During reperfusion exclusively, IABP support also improves LV contractility and active relaxation, possibly due to a synergistic effect of unloading and augmentation of coronary blood flow.

Impact of intra-aortic balloon pumping on hypotension and outcomes in acute right ventricular infarction.

This study investigated the immediate hemodynamic effects of intra-aortic balloon pump (IABP) support and clinical outcomes in patients with acute right ventricular infarction (RVI) complicated by hypotension. IABP improves hypotension in patients with acute myocardial infarction and left ventricular shock, but the effects have not been well studied in acute RVI with predominant right ventricular shock. We retrospectively analyzed hemodynamics and clinical outcomes in 32 patients with acute inferior ST elevation myocardial infarction complicated by RVI, in whom hypotension requiring IABP placement developed despite intact left ventricular ejection fraction. Pre-IABP hypotension was present in all (100%) patients, and in every case IABP augmentation increased mean arterial pressure (55.9±7.4 to 76.8±14.7 mmHg, P<0.0001). Adverse clinical events included respiratory distress requiring intubation in 46.9%, cardiopulmonary resuscitation in 25%, episodes of ventricular tachycardia/fibrillation in 56.3%, and transvenous pacemaker placement in 56.3% of patients. There were six inhospital deaths (18.8%). Pre-IABP hemodynamics were similar in those patients who survived to discharge compared with those who died. However, in those patients who died, there was significantly lower augmentation of peak systolic blood pressure during IABP support compared with survivors (2.7±17 vs. 27±22 mmHg, P<0.015). IABP support results in immediate hemodynamic improvement in patients with acute RVI complicated by shock. The majority of these shock patients survived and the magnitude of mean arterial pressure and peak systolic blood pressure augmentation may impart prognostic value.

Intra-aortic balloon pump for high-risk percutaneous coronary intervention.

The intra-aortic balloon pump (IABP) was first introduced into clinical practice in 1968.1 Early experimental and clinical trials suggested that intra-aortic balloon counterpulsation could provide circulatory assistance to a failing left ventricle.2,3 Counterpulsation—balloon inflation during diastole and deflation in systole—augments the intrinsic Windkessel effect, whereby potential energy stored in the aortic root during systole is converted to kinetic energy with the elastic recoil of the aortic root. Counterpulsation leads to a decline in afterload, a reduction in cardiac work, and therefore myocardial oxygen requirements of the ventricle. Augmentation of diastolic pressure when the balloon is fully inflated together with reduction in left ventricular (LV) filling pressures contribute to improved coronary perfusion (Figures 1 and 2).4 This proposed improvement in myocardial energetics has been further supported by a significant reduction in systemic lactate.5 These physiological enhancements are thought to be of particular benefit after acute myocardial infarction (AMI), supported by animal studies, which have shown a reduction in infarct size when counterpulsation is used.6,7 Figure 1. Coronary perfusion. Coronary flow is predominantly diastolic and further enhanced by counterpulsation, which augments diastolic blood flow and thus coronary perfusion. In addition, aortic recoil during diastole further improves efficiency of the left ventricle. Figure 2. Systemic arterial pressure waveform on introduction of intra-aortic balloon pump–assisted diastolic augmentation. The intra-aortic balloon pump inflates at the dicrotic notch, leading to peak-augmented diastolic pressure. As the balloon deflates, assisted end diastolic pressure is seen to be lower than unassisted end diastolic pressure and assisted systolic pressure is lower than unassisted systolic pressure. Peak diastolic augmentation should be greater than the unassisted systolic pressure and both assisted pressures should be less than the unassisted pressures. Intra-aortic balloon counterpulsation was initially used as a means of supporting patients undergoing surgical revascularization. Percutaneous delivery …

Effects of intra-aortic balloon pump on cerebral blood flow during peripheral venoarterial extracorporeal membrane oxygenation support.

BackgroundThe addition of an intra-aortic balloon pump (IABP) during peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) support has been shown to improve coronary bypass graft flows and cardiac function in refractory cardiogenic shock after cardiac surgery. The purpose of this study was to evaluate the impact of additional IABP support on the cerebral blood flow (CBF) in patients with peripheral VA ECMO following cardiac procedures.MethodsTwelve patients (mean age 60.40 ± 9.80 years) received VA ECMO combined with IABP support for postcardiotomy cardiogenic shock after coronary artery bypass grafting. The mean CBF in the bilateral middle cerebral arteries was measured with and without IABP counterpulsation by transcranial Doppler. The patients provided their control values. The mean CBF data were divided into two groups (pulsatile pressure greater than 10 mmHg, P group; pulsatile pressure less than 10 mmHg, N group) based on whether the patients experienced cardiac stun. The mean cerebral blood flow in VA ECMO (IABP turned off) alone and VA ECMO with IABP support were compared using the paired t test.ResultsAll of the patients were successfully weaned from VA ECMO, and eight patients survived to discharge. The addition of IABP to VA ECMO did not change the mean CBF (251.47 ± 79.28 ml/min vs. 251.30 ± 79.47 ml/min, P = 0.96). The mean CBF was higher in VA ECMO alone than in VA ECMO combined with IABP support in the N group (257.68 ± 97.21 ml/min vs. 239.47 ± 95.60, P = 0.00). The addition of IABP to VA ECMO support increased the mean CBF values significantly compared with VA ECMO alone (261.68 ± 82.45 ml/min vs. 244.43 ± 45.85 ml/min, P = 0.00) in the P group.ConclusionThese results demonstrate that an IABP significantly changes the CBF during peripheral VA ECMO, depending on the antegrade blood flow by spontaneous cardiac function. The addition of an IABP to VA ECMO support decreased the CBF during cardiac stun, and it increased CBF without cardiac stun.

Coronary and Microvascular Physiology During Intra-Aortic Balloon Counterpulsation

This study sought to identify the effect of coronary autoregulation on myocardial perfusion during intra-aortic balloon pump (IABP) therapy. IABP is the most commonly used circulatory support device, although its efficacy in certain scenarios has been questioned. The impact of alterations in microvascular function on IABP efficacy has not previously been evaluated in humans. Thirteen patients with ischemic cardiomyopathy (left ventricular ejection fraction: 34 ± 8%) undergoing percutaneous coronary intervention were recruited. Simultaneous intracoronary pressure and Doppler-flow measurements were undertaken in the target vessel following percutaneous coronary intervention, during unassisted and IABP-assisted conditions. Coronary autoregulation was modulated by the use of intracoronary adenosine, inducing maximal hyperemia. Wave intensity analysis characterized the coronary wave energies associated with balloon counterpulsation. Two unique diastolic coronary waves were temporally associated with IABP device use; a forward compression wave and a forward expansion wave caused by inflation and deflation, respectively. During basal conditions, IABP therapy increased distal coronary pressure (82.4 ± 16.1 vs. 88.7 ± 17.8 mm Hg, p = 0.03), as well as microvascular resistance (2.32 ± 0.52 vs. 3.27 ± 0.41 mm Hg cm s(-1), p = 0.001), with no change in average peak velocity (30.6 ± 12.0 vs. 26.6 ± 11.3 cm s(-1), p = 0.59). When autoregulation was disabled, counterpulsation caused an increase in average peak velocity (39.4 ± 10.5 vs. 44.7 ± 17.5 cm s(-1), p = 0.002) that was linearly related with IABP-forward compression wave energy (R(2) = 0.71, p = 0.001). Autoregulation ameliorates the effect of IABP on coronary flow. However, during hyperemia, IABP augments myocardial perfusion, principally due to a diastolic forward compression wave caused by balloon inflation, suggesting IABP would be of greatest benefit when microcirculatory reserve is exhausted.

Utility of Intra-Aortic Balloon Pump Support for Ventricular Septal Rupture and Acute Mitral Regurgitation Complicating Acute Myocardial Infarction

Clinical data on optimal management of mechanical complications of myocardial infarction are lacking. We retrospectively evaluated the effect of intra-aortic balloon pump (IABP) on 30-day survival in patients with postinfarction ventricular septal rupture (VSR, n= 55) or acute mitral regurgitation (MR, n= 26) who developed either cardiogenic shock (n= 46) or severe hemodynamic instability that did not fulfill the criteria of shock (n= 35). IABP was inserted in 83% of the patients with shock and 57% of those without shock. Thirty-five (76%) patients with shock and all unstable patients survived until surgical repair, which was performed within a median (interquartile range) of 1 (1 to 2) and 9 (2 to 18) days from the onset of the complication (p <0.001). All patients who did not undergo the operation died within 3days. Although MR presented more acutely, the patients' outcomes were similar to those with VSR. IABP support reduced 30-day mortality in the patients with shock (61% vs 100%, p= 0.04) but not in the patients without shock (20% vs 27%, p= 0.7). The benefit of IABP support in the shock cohort was driven mainly by reduction of preoperative mortality (11% vs 88%, p <0.001). Early progression of cardiogenic shock and unperformed surgery were the only independent predictors of 30-day mortality (hazard ratio 3.4, 95% confidence interval 1.5 to 8 and hazard ratio 5.1, 95% confidence interval 2.2 to 11, respectively; p= 0.004 and p <0.001, respectively). In conclusion, we suggest that all patients with postinfarction VSR or acute MR with signs of cardiogenic shock should immediately receive IABP as a bridge to emergent surgical repair. In contrast, hemodynamically unstable patients without shock may be first stabilized by medical therapy, without additional benefit of IABP, before they undergo cardiac surgery.

Short and long term effect of adjunctive intra-aortic balloon pump use for patients undergoing high risk reperfusion therapy: a meta-analysis of 10 international randomised trials

ObjectiveCurrent literature shows there is widespread controversy regarding the indications and outcomes of using an intra-aortic balloon pump (IABP); furthermore, little is known about the late effects of IABP use.DesignTo...

Intra-aortic balloon pump in high-risk percutaneous coronary interventions without cardiogenic shock: Trial sequential analysis of outcomes

In evaluating the effectiveness of intra-aortic balloon pump in high-risk percutaneous coronary interventions without cardiogenic shock, the best level of evidence in the meta-analysis by Romeo and co-workers [ [1] Romeo F. Acconcia M.C. Sergi D. et al. Lack of intra-aortic balloon pump effectiveness in high-risk percutaneous coronary interventions without cardiogenic shock: a comprehensive meta-analysis of randomised trials and observational studies. Int J Cardiol. 2013; 167: 1783-1793 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ] was that obtained from randomized controlled studies (RCTs). With regard to the end-point of in-hospital major adverse cardiac events (MACEs), interpreting the results of the RCTs included in this meta-analysis is made difficult by the nonsignificant difference found between patients who were given intra-aortic balloon pump and the controls. Nonsignificant meta-analyses are increasingly being recognized to be a matter of controversy mainly because their results can be classified as either inconclusive (i.e., no proof of difference) or demonstrated futility (i.e., proof of no difference), and these two categories differ much more than is commonly thought [ 2 Wetterslev J. Thorlund K. Brok J. Gluud C. Estimating required information size by quantifying diversity in a random-effects meta-analysis. BMC Med Res Methodol. 2009; 9 Crossref PubMed Scopus (647) Google Scholar , 3 Wetterslev J. Thorlund K. Brok J. Gluud C. Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol. 2008; 61: 64-75 Abstract Full Text Full Text PDF PubMed Scopus (1182) Google Scholar , 4 Arruda M.A. No evidence of efficacy or evidence of no efficacy. JAMA Pediatr. 2013 Mar 1; 167: 300-302 Crossref PubMed Scopus (18) Google Scholar ].

Effects of Intra‐Aortic Balloon Pump Timing on Baroreflex Activities in a Closed‐Loop Cardiovascular Hybrid Model

Despite 50 years of research to assess the intra-aortic balloon pump (IABP) effects on patients' hemodynamics, some issues related to the effects of this therapy are still not fully understood. One of these issues is the effect of IABP, its inflation timing and duration on peripheral circulation autonomic controls. This work provides a systematic analysis of IABP effects on baroreflex using a cardiovascular hybrid model, which consists of computational and hydraulic submodels. The work also included a baroreflex computational model that was connected to a hydraulic model with a 40-cm(3) balloon. The IABP was operated at different inflation trigger timings (-0.14 to 0.31 s) and inflation durations (0.05-0.45 s), with time of the dicrotic notch being taken as t = 0. Baroreflex-dependent parameters-afferent and efferent pathway activity, heart rate, peripheral resistance, and venous tone-were evaluated at each of the inflation trigger times and durations considered. Balloon early inflation (0.09 s before the dicrotic notch) with inflation duration of 0.25 s generated a maximum net increment of afferent pathway activity of 10%, thus leading to a decrement of efferent sympathetic activity by 15.3% compared with baseline values. These times also resulted in a reduction in peripheral resistance and heart rate by 4 and 4.3% compared with baseline value. We conclude that optimum IABP triggering time results in positive effects on peripheral circulation autonomic controls. Conversely, if the balloon is not properly timed, peripheral resistance and heart rate may even increase, which could lead to detrimental outcomes.

Left‐to‐right shunt reduction with intra‐aortic balloon pump in postmyocardial infarction ventricular septal defect

This case aims to describe the hemodynamic effects of intra-aortic balloon pump (IABP) in patients with ventricular septal defect (VSD) complicating myocardial infarction (MI). A 79-year-old man with no previous cardiovascular history presented to the emergency department with subacute inferior myocardial infarction associated with mild signs of systemic hypoperfusion. A transthoracic echocardiography revealed a large akinesia of the left ventricular inferior wall with preserved global left ventricular ejection fraction, as well as a large VSD in the midinferior portion of the interventricular septum. Coronary angiography showed an occlusion of the mid portion of a dominant circumflex coronary artery. The invasive hemodynamic evaluation showed a sizable left-to-right shunt (Q(p)/Q(s) = 3.1). Activation of the IABP led to an immediate reduction of the shunt (Q(p)/Q(s) = 2.4 = 22% reduction), an increase in systemic cardiac output (from 2.1 L/min to 2.4 L/min = +12%) and a decrease in the systemic vascular resistances (from 2240 to 1920 dyne-sec/cm(5) = 15% reduction). In patients with post-MI VSD, placement of IABP leads to an immediate reduction in left-to-right shunt and as a consequence to an increase in systemic cardiac output, which may allow hemodynamic stabilization of the patient prior to surgical VSD closure.

High Risk Percutaneous Coronary Intervention and Intra-Aortic Balloon Pumps

The goal of percutaneous coronary intervention (PCI) is to decrease the coronary obstruction in a durable manner without compromising or damaging the myocardium so that patients may obtain the clinical benefits from the procedure, namely potentially improved survival in the setting of acute myocardial infarction interventions and improvement in health status for elective interventions. Interventional cardiologists make decisions each day aimed at improving the likelihood of both procedural success and resultant patient outcomes. These wide-ranging decisions include procedural planning, adjunctive pharmacotherapy, and device therapy for both coronary devices and possible use of various hemodynamic support devices. It is in this framework that the effectiveness of intra-aortic balloon pump (IABP) counterpulsation devices must be considered because they represent a common tool that interventional cardiologists use for procedure and patient support. Article see p 21 IABP counterpulsation was first reported in 1968 as a cardiac-assist device in a patient with cardiogenic shock,1 which supported the patient as shock resolved. As an adjunctive hemodynamic support device, the intra-aortic balloon is timed with the cardiac cycle to inflate at the start of diastole, augmenting diastolic pressure, which increases coronary perfusion and oxygen delivery to the myocardium. It is timed to deflate just before the start of systole, thereby reducing afterload. This facilitates ejection of blood from the left ventricle (LV) by decreasing LV work and reducing myocardial oxygen demands,2 resulting in increased cardiac output. …

Abstract P155: Perioperative Intra-Aortic Balloon Pump Counterpulsation and Outcomes in Very Elderly

Introduction: Indications for use of intra aortic balloon pump (IABP)are low ejection fraction, shock, left main stem disease, unstable angina, refractory angina and redo operation. These were supported by trials which included few very elderly patients (older than 80). Octogenarians are increasingly undergoing Coronary artery bypass surgery often needing IABP use. Hypothesis: we plan to test the utility and effectiveness of IABP in improving outcomes in very elderly patients undergoing isolated coronary artery bypass grafting (CABG). Methods: We performed a retrospective analysis of very elderly patients who underwent coronary artery bypass from 01/2001 to 12/2008. Statistical analysis is performed by STATA. Results: A total of 450 patients older than 80 underwent CABG during eight years. The mean age of the total subjects was 83.16+/- 2.48. A total of 35 (7.78%) patients underwent perioperative IABP of whom 14 (40%) died. Mortality among Non-IABP group was 7.47% (31/415).This was statistically significant at p&lt;0.000.Higher mortality in IABP group was seen across all the subset of patients with accepted guideline based indication including shock, low EF, Left main stem disease, Unstable angina. Higher mortality was also seen in other risk factors like CHF, renal failure. Patients who underwent IABP placement experienced other adverse outcomes like longer mean extubation time of 151.6 hrs (CI 24-301 ) compared to 27.03 hrs ( CI 19 - 34.07) in Non-IABP group. Need for more than two inotropes was 44% (11/25) in IABP whereas it was 4.84 % (17/351) in Non-IABP group. No clear relation to postoperative atial fibrillation was found. Post operative renal failure was 9.38 (3/32) in IABP group compared to 2.24(9/401) in Non IABP group with a p &lt;.01.We didn't had enough power to look into post-operative Cerebrovascular accident. In multivariate regression analysis after adjustment for confounding variable placement IABP has higher mortality with an OR 2.31 (1.14-3.48) p&lt;.0001 Conclusions: In very elderly patients mortality rate is very high even for indications supported by ACC/AHA guidelines. We need prospective studies focusing on very elderly patients.

Increased Coronary Blood Flow and Cardiac Contractile Efficiency With Intraaortic Balloon Counterpulsation in a Porcine Model of Myocardial Ischemia-Reperfusion Injury

The evaluation of the impact of intraaortic balloon pump (IABP) on postischemic coronary perfusion and myocardial contractile impairment has been so far limited to early reperfusion phase. Therefore, we analyzed the 24-hour effects of IABP on coronary blood flow (CBF) and left ventricular performance in an animal model of acute myocardial ischemia-reperfusion injury. Healthy swine (n = 20) underwent 120-minute ligation of the left anterior descending coronary artery followed by 24 hours of reperfusion. We randomly assigned the animals to have IABP placed in the descending aorta 5 minutes after reperfusion onset (n = 10) or to undergo no implantation (n = 10). We measured CBF, coronary resistance, cardiac cycle efficiency (CCE), and maximal pressure/time ratio before ischemia was induced and at 30 minutes and 1, 6, 12, and 24 hours after reperfusion began. During diastole, CBF was significantly increased in IABP compared with baseline and controls at all time points (all p < 0.001). This was also true during systole in IABP only for the first hour after reperfusion began. Additionally, both CCE and pressure/time ratio were significantly increased in IABP compared with baseline at 30 minutes and 1 hour after reperfusion began (p < 0.001). IABP was associated with enhanced CBF and cardiac efficiency in a model of acute ischemic-reperfusion injury.

Response to Letter Regarding Article, “Visceral Arterial Compromise During Intra-Aortic Balloon Counterpulsation Therapy”

HomeCirculationVol. 123, No. 18Response to Letter Regarding Article, “Visceral Arterial Compromise During Intra-Aortic Balloon Counterpulsation Therapy” Free AccessReplyPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReplyPDF/EPUBResponse to Letter Regarding Article, “Visceral Arterial Compromise During Intra-Aortic Balloon Counterpulsation Therapy” Ardawan Julian Rastan, Eugen Tillmann and Sreekumar Subramanian Lukas Lehmkuhl Anne Kathrin Funkat, Sergej Leontyev, Torsten Doenst and Thomas Walther Matthias Gutberlet Friedrich Wilhelm Mohr Ardawan Julian RastanArdawan Julian Rastan Search for more papers by this author , Eugen TillmannEugen Tillmann Search for more papers by this author and Sreekumar SubramanianSreekumar Subramanian Search for more papers by this author Lukas LehmkuhlLukas Lehmkuhl Search for more papers by this author Anne Kathrin FunkatAnne Kathrin Funkat Search for more papers by this author , Sergej LeontyevSergej Leontyev Search for more papers by this author , Torsten DoenstTorsten Doenst Search for more papers by this author and Thomas WaltherThomas Walther Search for more papers by this author Matthias GutberletMatthias Gutberlet Search for more papers by this author Friedrich Wilhelm MohrFriedrich Wilhelm Mohr Search for more papers by this author Originally published10 May 2011https://doi.org/10.1161/CIRCULATIONAHA.110.016154Circulation. 2011;123:e589With great interest, we read the letter from Dr Michael Poullis concerning our recently published article on the adverse effects of intra-aortic balloon pump (IABP) malposition and anatomic-to-device mismatch on visceral organ function.1First, with respect to IABP position, we defined the correct proximal position of the tip as 1 to 2 cm distal to the left subclavian artery origin because this position is generally taught, and it is recommended by the IABP manufacturers. Although there may be a rationale for an alternative position, no scientific data exist to support alternative positioning. Therefore, our analysis was based on the gold standard of IABP position.Second, we agree that high-quality transesophageal echocardiography in particular, when done by experienced clinicians, allows for identification of celiac trunk coverage and appropriate balloon adjustment.2 However, in most institutions, this is not a standard assessment. Perhaps this discussion will serve to increase the use of transesophageal echocardiography to assess distal balloon position. At the same time, it should be noted that transesophageal echocardiography is powerless to compensate for a balloon that is too long anatomically.Finally, we agree that, in aortas with sufficient transverse diameter, the issue of a diastolic malperfusion may not be clinically relevant. However, we had speculated in our article that, in patients with small aortas, complete aortic occlusion may potentially lower the overall visceral artery perfusion, even if systolic perfusion is unaffected.Finally, we agree that visceral artery compromise during IABP support is generally only a cofactor for the development of visceral ischemic complications in these critically ill patients with vasopressor requirements, low output syndrome, and intermittent hypotension. However, IABP support was recently found to be an independent risk factor for acute kidney injury after coronary artery bypass surgery,3 and may have a more direct role in visceral ischemic complications than previously believed. The major aim of our study was to demonstrate that the combination of a low balloon position and anatomic-to-device length mismatch occur frequently in clinical practice and can induce diastolic vascular obstruction or debris embolization. It is hoped that this will serve to remind clinicians of the role that the IABP may play in unexpected visceral malperfusion syndromes.Ardawan Julian Rastan, MD, PhDEugen Tillmann, MDSreekumar Subramanian, MD Department of Cardiac Surgery Heart Center University of Leipzig Leipzig, GermanyLukas Lehmkuhl, MD Department of Radiology Heart Center University of Leipzig Leipzig, GermanyAnne Kathrin Funkat, PhDSergej Leontyev, MDTorsten Doenst, MD, PhDThomas Walther, MD, PhD Department of Cardiac Surgery Heart Center University of Leipzig Leipzig, GermanyMatthias Gutberlet, MD, PhD Department of Radiology Heart Center University of Leipzig Leipzig, GermanyFriedrich Wilhelm Mohr, MD, PhD Department of Cardiac Surgery Heart Center University of Leipzig Leipzig, GermanyDisclosuresNone.

The clinical application of intra-aortic balloon pumping in treating serious coronary heart disease

Objective To evaluate the effect of intra-aortic balloon pumping(IABP)in treating serious coronary heart disease. Methods A retrospective analysis was performed on 19 patients who suffered from serious coronary heart disease and accepted IABP therapy,the differences of mean arterial pressure before and after treatment were compared.In order to compare the in-hospital mortality,the patients were divided into 2 groups:6 of 19 patients accepted single IABP therapy,13 of 19 patients attempted IABP and revascularization(thrombolytic/percutaneous coronary intervention/coronary artery bypass graft)therapy. Results Bedside success rate of IABP operation was 100%without complication.Effective rate was 89.5%(17/19),2 patients who were irreversible phase of cardiogenic shock,were an ineffective treatment.The patient's mean arterial pressure increased from(52.1 ± 18.4)mm Hg to(78.3 20.8)mm Hg after using IA BP for 30 minutes(P＜0.01).The in-hospital mortality was significantly lower in patients received revascularization therapy in addition to IABP compared with patients who had IABP support alone 7.7% vs 83.3%(P＜0.01). Conclusion IABP in treating serious coronary heart disease was safe and effective.IABP treatment before irreversible phase of shock and revascularization therapy following IABP are the key to decrease in-hospital mortality. Key words: Intra-aortic balloon pumping; Therapeutics

Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support

ObjectiveTo investigate the haemodynamic effects of intra-aortic balloon pump (IABP) support in patients with severe aortic stenosis (AS) presenting in cardiogenic shock (CS).DesignObservational cohort study.SettingTertiary academic centre coronary intensive care...