Intra-aortic Balloon Pump Therapy Research Articles

Discrepancy between two invasive blood pressure measurements in patients receiving intra-aortic balloon pump therapy

BackgroundHemodynamic monitoring is imperative for patients with cardiogenic shock undergoing Intra-aortic Balloon Pump (IABP) therapy. Blood pressure monitoring encompasses non-invasive, invasive peripheral arterial pressure (IPAP), and invasive central aortic pressure (ICAP) methods. However, marked disparities exist between IPAP and ICAP. This study examined the discrepancies between IPAP and ICAP and their clinical significance.MethodsA retrospective analysis was conducted on cardiogenic shock patients who underwent IABP therapy and were admitted to the Coronary Care Unit (CCU) of a tertiary hospital in China from March 2017 to November 2022. The Bland–Altman plot illustrated the discrepancy between IPAP and ICAP. A clinically significant difference between ICAP and IPAP measurements was defined as ≥ 10 mmHg, which could necessitate alterations in blood pressure management according to current guidelines that recommend maintaining a mean arterial pressure (MAP) ≥ 70 mmHg.ResultsIn total, 162 patients were included in the final analysis. In patients without vasopressors, the difference between ICAP and IPAP was 5.73 mmHg (95% limits of agreement [LOA], -16.98 to 28.44), whereas, in patients with vasopressors, it was 4.36 mmHg (95% LOA, -17.31 to 26.03). ICAP measurements exceeded IPAP in patients undergoing IABP therapy. However, the difference was not statistically significant between the two groups. Multivariate logistic regression revealed that higher serum lactate levels (Odds ratio [OR], 1.14; 95% confidence interval [CI], 1.03–1.27; p = 0.013) and age ≥ 60 years (OR, 13.20; 95% CI, 1.50–115.51; p = 0.020) were associated with an increased likelihood of a clinically significant MAP discrepancy. Conversely, a history of coronary heart disease was associated with a decreased likelihood (OR, 0.34; 95% CI, 0.13–0.90; p = 0.031).ConclusionsNotable discrepancies between ICAP and IPAP measurements exist in cardiogenic shock patients undergoing IABP therapy. ICAP exceeds IPAP, and factors such as age ≥ 60 years, elevated lactic acid levels, and absence of coronary heart disease contribute to this discrepancy. Enhanced vigilance is warranted for these patients, and the consideration of peripheral invasive monitoring in conjunction with IABP therapy is advised.

P80: Adding Intra-Aortic Balloon Pump Counter-Pulsation To Vasodilator Therapy Results In Better Organ Perfusion In Patients With Biventricular Heart Failure Awaiting A Heart Transplant

Background: Significant right ventricular dysfunction with elevated central venous pressure is associated with poor survival in heart failure patients with reduced ejection fraction (HFrEF). Heart transplant is often the only option for this group of patients, as they are not candidates for left ventricular assist device therapy. Medical management of HFrEF involves lowering the systemic afterload with vasodilators. While this therapy is very effective in isolated left ventricular dysfunction, in patients with biventricular dysfunction and high venous pressure, vasodilation can lead to low organ perfusion pressure, resulting in organ dysfunction. Organ perfusion pressure is calculated as the difference between mean arterial pressure and central venous pressure. We hypothesized that combining intra-aortic balloon pump (IABP) counter-pulsation with vasodilator therapy might be a good clinical option for stabilizing these patients while awaiting a heart transplant. Methods: To understand the hemodynamics of vasodilator and IABP therapy in biventricular heart failure, we used a closed-loop multiscale model of the entire cardiovascular system, including a one-dimensional model of the arterial tree coupled with a lumped model of the heart and IABP counter-pulsation. In addition, a baroreceptor model was also used to capture the physiological changes secondary to ventricular dysfunction realistically. Results: Our mathematical model accurately captures the features of the aortic pressure waveform with IABP support (Figure 1) and the hemodynamic consequences of the onset of right ventricular dysfunction (Table 1). Biventricular dysfunction leads to lower cardiac output and organ perfusion pressure when compared with isolated left ventricular dysfunction. Vasodilation during biventricular dysfunction increases the cardiac output but reduces the organ perfusion pressure further. IABP counter-pulsation increases cardiac output along with higher mean arterial pressure and hence higher organ perfusion pressure. The best results are seen when vasodilators are used in conjunction with IABP, where a “sweet spot” of maximal increase in cardiac output with the best possible organ perfusion pressure is obtained, and this combined additive effect of IABP counter-pulsation and vasodilation is also reflected across the renal vasculature (Table 1). Conclusion: Vasodilation with high venous pressure can lead to low organ perfusion pressure and consequent organ dysfunction. Fine-tuning IABP counter-pulsation and vasodilator seems to confer a substantial hemodynamic benefit in this setting.Figure 1. Simulated aortic pressure waveform with IABP support

A case of dynamic LVOTO after acute myocardial infarction with hemodynamic compromise after intra-aortic balloon pumping and inotropic therapy

A case of dynamic LVOTO after acute myocardial infarction with hemodynamic compromise after intra-aortic balloon pumping and inotropic therapy

Perfusionist removal of intra-aortic balloon pump catheters improves efficiency without an increase in complication rates.

The intra-aortic balloon pump (IABP) is one of the most utilized cardiac assist devices. Patients receiving IABP therapy are typically managed in high acuity clinical care areas with limited bed space and high demand. Our center instituted a certified clinical perfusionist (CCP) led initiative to remove IABP catheters in order to reduce IABP therapy time, hasten removal and improve efficiency. The purpose of the study is to compare outcomes for IABP removal by a certified clinical perfusionist to a physician. The primary outcome measures were site hematoma score and limb related complications. A survey was submitted to bedside nurses, managers/patient care coordinators, CCP's and physicians. The IABP quality assurance database was interrogated for the study. There were 350 patients eligible for inclusion. The cohort was well balanced between CCP (n = 284) and physician (n = 66) groups for patient demographics, indication, insertion specifics and type of medical intervention. The majority of patients had no bruise or hematoma with perfusionist (n = 246, 87%) or physician (n = 58, 88%) (p = 0.78) removal. The physician group demonstrated a higher rate of grade 3 hematomas (p = 0.03). There was no statistically significant difference between CCP and physician groups for limb complications and mortality. Survey results showed an improved efficiency in bed space allocation, physician workload and a decreased IABP support time. There is no difference in limb complications between perfusionist and physician removal of IABP catheters. The survey demonstrate an improvement in resource allocation and efficiency. A perfusionist led IABP removal program can be done safely and may help improve program efficiency.

Abstract 10170: Comparison of Impella, Intra-Aortic Balloon Pump, and Vasopressors Alone in Patients With Acute Myocardial Infarction and Cardiogenic Shock Undergoing Percutaneous Coronary Intervention

Introduction: Previous studies have compared Impella to intra-aortic balloon pump (IABP) in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) but did not include a cohort of patients receiving vasopressors alone. We assessed the hypothesis that there would be a difference in clinical outcomes in patients with AMI-CS undergoing PCI who received Impella alone, IABP alone, and vasopressor therapy without MCS. Methods: We queried the National Inpatient Sample inclusive of 2015 to 2018 and created three propensity-matched cohorts (Impella alone vs IABP alone, Impella alone vs vasopressors without MCS, and IABP alone vs vasopressors without MCS). We performed propensity matching by adjusting for 21 clinical variables including age, comorbidities, and presence of lactic acidosis. Patients receiving both MCS and vasopressors were excluded, in order to best isolate the effect of each intervention. Results: Among 17,762 hospitalized patients with AMI-CS undergoing PCI, Impella use was associated with significantly higher in-hospital mortality (40.6% vs 27.4%; p=0.003), major bleeding (29.3% vs 13.5%; p < 0.001), acute kidney injury (56.4% vs 45.9%; p=0.04), and hospital charges compared to IABP use (p <0.001) (Figure). Impella patients had significantly higher rates of mortality (42.8% vs 35.5%; p=0.01) and major bleeding (32.7% vs 22.5%; p=0.001), when compared to patients with vasopressors without MCS. There were no significant differences in clinical outcomes between IABP patients and patients receiving vasopressors without MCS. Conclusions: When compared to IABP or vasopressor therapy without MCS, Impella patients with AMI-CS undergoing PCI had higher mortality, major bleeding, and in-hospital costs. A vasopressor-only strategy showed no difference in clinical outcomes when compared to IABP. Randomized trials are necessary to determine optimal MCS management in AMI-CS.

Intra-aortic balloon pump in patients with acute advanced heart failure. Results from a single-center study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with advanced heart failure are frequently referred to cardiac intensive care unit (CICU) for hemodynamic support. Despite optimum pharmacological therapy many of these patients persist in critical condition, demanding short term circulatory support until recovery or heart transplantation. Intra-aortic balloon pump is commonly used in patients with advanced heart failure in order to stabilize hemodynamically compromised patients as bridge to decision for further therapies. Purpose To investigate the outcomes of patients with acute advanced heart failure referred to cardiac intensive care unit and supported with short term mechanical support. To explore the hemodynamic effects of the Intra-aortic balloon pump therapy in these patients. Material & Method We retrospectively analyzed the data from 104 patients with acute advanced heart failure (either as worsening of existing symptoms of chronic HF or as first onset of HF). All patients had severe left ventricular dysfunction, which was frequently associated with right ventricular dysfunction and increased NT pro BNP levels. Demographic data were collected including co-morbidities. Laboratory data included NT-pro BNP, total bilirubin, serum creatinine, urea and baseline e GFR (MDRD Formula). All patients received IABP support and underwent right heart catheterization. Measurements were made before and after the insertion of the IABP. The study has been approved by the Scientific Committee and the Ethics Committee of the Hospital. Results The mean age of the sample was 44 ± 12 years. 76 patients (73, 08%) were male. 20 patients (19, 23%) were of ischemic etiology. The median time on IABP support for the entire cohort was 13 days (3 – 41, 25). There was statistically significant decrease in the NT-pro BNP levels (p<0, 0001). There was improvement in renal function (e GFR (p<0, 0001) and urea levels (p< 0,001)). There was statistically significant improvement in the right heart catheterization measurements (decrease of the right atrium pressure (p <0, 0001), of the PA pressure (p<0,001), and of the pulmonary capillary wedge pressure (p<0,001)). IABP provided clinical stabilization in 88 patients (87, 62%), that is completed pre-transplant evaluation and proceeded in surgery with permanent mechanical support or heart transplantation or transfer to regular ward, while 16 patients (15, 38%) ended up in CICU while being on IABP. Conclusions In this single center study the use of IABP improved the laboratory findings and the hemodynamic status of patients admitted in the cardiac intensive care unit with acute advanced heart failure. It was an effective method of managing patients as bridge to decision for further therapies.

Significant vascular complications in percutaneous axillary intra-aortic balloon pump

ObjectiveAxillary Intra-aortic balloon pump (IABP) has been increasingly utilized for hemodynamic support in heart failure patients. Vascular complications associated with axillary IABP such as dissection or rupture are relatively rare but not negligible that could negatively affect clinical outcomes. We summarized our experiences. MethodsThis is a retrospective study reviewing of all patients receiving an axillary IABP between June 2016 and November 2020. A total of 199 patients underwent percutaneous axillary IABP placement. 6 patients (6/199, 3.0%) were complicated with arterial/aortic dissection or rupture during the procedures or the course of treatment. We described their clinical presentations and outcomes. ResultsVascular complications included acute type A aortic dissection in 2 patients, descending aortic rupture in 1 patient, abdominal aortic rupture along with type B aortic dissection in 1 patient, and the localized left subclavian artery dissection in 2 patient. 2 type A aortic dissection cases were surgically treated: 1 with emergent left ventricle assist device and ascending aorta replacement, the other with emergent left ventricle assist device. Emergent endovascular treatment was successfully performed in 2 aortic rupture cases. The left subclavian artery dissection cases were managed medically. The postoperative/treatment course was uneventful in all patients. ConclusionPercutaneous axillary IABP therapy can cause significant vascular complications. Early diagnosis and prompt treatment would be the key to improve the clinical outcomesv.

Concomitant ECMO And IABP Support in Postcardiotomy Cardiogenic Shock Patients

Simultaneous mechanical circulatory support (MCS) with intra-aortic balloon pump (IABP) to extracorporeal membrane oxygenation (ECMO) is common in postcardiotomy cardiogenic shock (PCS). This study aimed to analyse the effect of concomitant ECMO and IABP therapy on the short-term outcomes of patients with PCS. Between March 2006 and March 2017, 172 consecutive patients with central (c) or peripheral (p) veno-arterial ECMO therapy due to PCS were identified at the current institution and included in this retrospective analysis. Patients were divided into ECMO+IABP and ECMO alone groups. Further, the impact of ECMO flow direction was analysed for the groups. A total of 129 patients received ECMO+IABP support and 43 patients were treated with ECMO alone. Median ECMO duration did not differ between the groups (68 [34; 95] hours ECMO+IABP vs 44 [20; 103] hours ECMO; p=0.151). However, a trend toward a higher weaning rate was evident in ECMO+IABP patients (75 [58%] ECMO+IABP vs 18 [42%] ECMO; p=0.078). Concomitant IABP support with either cECMO (73% [n=24] cECMO+IABP vs 50% [n=11] ECMO; p=0.098) or pECMO (57% [n=55] ECMO+IABP vs 33% [n=7] ECMO; p=0.056) was also associated with a trend toward a higher weaning rate off ECMO. In-hospital mortality did not differ between the groups. This analysis found that, independent of ECMO type, additional IABP support might increase ECMO weaning; however, it did not influence survival in PCS patients. Larger studies are necessary to further analyse the impact of this concomitant MSC therapy on clinical outcomes.

Abstract 305: Contemporary Analysis of Percutaneous Intraaortic Balloon Pump Therapy as a Bridge to Orthotopic Heart Transplant

Objective: Intra-aortic balloon pump (IABP) support has been used as a bridge to transplant (BTT) therapy for acutely deteriorating patients awaiting orthotopic heart transplantation (OHT). Given recent changes to the heart allocation algorithm which have expanded IABP use for BTT, the evaluation of device strategy, complications, and near-term survival is warranted. Methods: Patients bridged with IABP who underwent OHT between October 2018 and January 2020 at our institution were retrospectively reviewed (n=21). Chart review was conducted to assess IABP insertion site, timing of support, device-related complications, removal strategy, and thirty-day post-transplant mortality. Results: Patients were bridged with femoral (n=6), axillary (n=9), or femoral with axillary conversion (n=6) approaches for IABP insertion. Common complications included pump malposition (n=5), hematuria (n=4), pump exchange (n=9), and insertion site bleeding (n=2). Median duration of IABP support was 12 [7, 18] days and median time to removal after OHT was 1 [1, 2] day. IABP removal occurred at the bedside with direct pressure application for all femoral pumps (n=6). Among axillary pumps (n=15), 11 were removed at the bedside with direct pressure, 3 were removed in the operating room, and 1 was removed in the catheterization lab with device closure. There was no thirty-day mortality following OHT. Conclusion: Following the changes to the heart allocation algorithm, IABP has become the most common method of temporary mechanical circulatory support for patients awaiting OHT at our center with excellent early survival and acceptable complication rates. In addition to allowing patients to ambulate while on IABP, we find that axillary insertion did not result in excess bleeding complications and that bedside removal with direct pressure was a safe method for postoperative decannulation.

Intra-aortic balloon pump as a bridge therapy to heart transplant in refractory heart failure

Abstract Background The role of intra-aortic balloon pump (IABP) in advanced heart failure (HF) treatment is still under debate. Some heart transplant (HTx) candidates on the waiting list require mechanical support, and IABP may be the simple and most available device. Purpose Describe the impact of IABP treatment in advanced HF patients who underwent HTx. Methods We retrospectively analysis patients who underwent HTx from a single center intensive care unit (ICU), between 2009 and 2018, to evaluate the use of IABP as bridge therapy. Selection included decompensated chronic HF patients that required intensive care with optimized intravenous drugs before IABP placement. Exclusion criteria were acute myocardial infarction or cardiac surgery 90 days prior to admission, and implant of ventricular assist device before HTx. Results We included 134 HF patients with IABP therapy before HTx. Insertion site was exclusively femoral. Mean time of IABP onset to HTx were 26±21 days, and hospital admission to HTx 65±45 days. The main cardiomyopathy etiology was Chagas Disease (46%) and mean LVEF was 23±6% (TABLE 1). Clinical and laboratory data were compared before and 96 hours after IABP therapy. Mean central venous oxygen saturation (SvO2) increased from 49.7±14.6% to 67.4±11.3% (p<0.001), creatinine decreased from 1.77±0.9 mg/dL to 1.40±0.6 mg/dL (p<0.001), and urine output increased from 1552±886 mL/24h to 2189±1029 mL/24h (p<0.001). These differences were sustained or improved until the day before HTx (FIGURE 1). After 96 hours dobutamine was maintained in 98% of patients, nitroprusside increased from 56% to 67%, milrinone decreased from 26% to 20%, and norepinephrine decreased from 18% to 3%. Significant IABP complications were few (5.2%; n=7: 3 infections, 2 major bleeding, 2 arterial injury). Conclusion In this single center ICU sample, IABP improved hemodynamic status and renal function in refractory HF patients waiting for HTx. IABP can be a reasonable, available and effective bridging therapy. Figure 1 Funding Acknowledgement Type of funding source: None

Timing of initiation of intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: A meta-analysis.

BackgroundFor patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) undergoing primary percutaneous coronary intervention (PCI), the optimal timing of the initiation of intra‐aortic balloon pump (IABP) therapy remains unclear. Therefore, we performed the first meta‐analysis to compare the outcomes of IABP insertion before vs after primary PCI in this population.MethodsElectronic databases of PubMed, EMBASE, and Cochrane Library were comprehensively searched from inception to April 1, 2019, to identify the eligible studies. The main outcomes were short‐term (in‐hospital or 30 days) and long‐term (≥ 6 months) mortality. In addition, pooled analysis of risk‐adjusted data were also performed to control for confounding factors.ResultsSeven observational studies and two sub‐analysis of randomized controlled trials involving 1348 patients were included. Compared to patients inserted IABP after PCI, patients who received IABP therapy before primary PCI had similar risks of short‐term (odds ratio [OR] 0.88, 95% CI 0.49 to 1.59) and long‐term (OR 0.99, 95% CI 0.58 to 1.68) all‐cause mortality. Moreover, a pooled analysis of risk‐adjusted data also found similar effects of the two therapies on short‐term (OR 0.65, 95% CI 0.34 to 1.25) and long‐term (OR 0.68, 95% CI 0.17 to 2.72) mortality. Besides, no significant difference was found between the two groups with respect to reinfarction, repeat revascularization, stroke, renal failure, and major bleeding.ConclusionsThe timing of the initiation of IABP therapy does not appear to impact short‐term and long‐term survival in patients with AMI complicated by CS undergoing primary PCI.

Bridging Strategies and their Association with Post Heart Transplant Outcomes

Objective Heart transplant (HT) remains the definitive therapy for patients with end stage heart failure (HF). The rate of heart transplantation is limited by the availability of suitable donors, and thus waiting time varies. Bridging strategies have been implemented to stabilize hemodynamics and alleviate debilitating symptoms of HF in patients awaiting HT. In this study we performed a comparative analysis of bridging strategies and their association with post HT outcomes. Methods This was an analysis of 20,919 adult HT recipients captured in the United Network for Organ Sharing (UNOS) heart transplant registry that were bridged to transplant utilizing a bridging strategy inclusive of a left ventricular assist device (VAD), Intra-aortic balloon pump (IABP), or intravenous inotropic agents. Outcomes of interest included graft failure and patient survival. Chi square analysis was used to detect baseline differences between the three groups. Competing risk analysis was used to assess the outcomes of interest. Results In each group HT recipients were predominately Caucasian, and male with a median ischemic time of 3.2 hours (Table 1). Median patient survival was significantly highest in the Inotrope group, and lowest in the IABP group (1648 vs 828 days p= Conclusions Among bridging strategies inclusive of LVAD, IABP and intravenous intropic therapy, long term median survival was observed to be longest in those bridged with intravenous inotropes. No difference in the outcome of acute graft failure was observed. Further analysis is needed to understand the survival differences observed in this study.

Predictors of Hemodynamic Response to Intra-Aortic Balloon Pump Therapy in Patients with Acute Decompensated Heart Failure and Cardiogenic Shock

Introduction There is renewed interest in the utility of the intra-aortic balloon pump (IABP) for short-term and durable support in patients with chronic systolic heart failure (HF) who present with acute decompensation and cardiogenic shock (CS). However, the clinical characteristics of IABP-responders and non-responders remain incompletely defined. We sought to identify predictors of early IABP response to guide optimal use of IABP therapy in this population. Methods We retrospectively analyzed the records of chronic systolic HF patients who presented at our institution between 2011-2018 with acute decompensated HF with hemodynamic evidence of CS and underwent IABP placement. IABP-responder was defined as having an immediate increase in cardiac output (CO) and an immediate decrease in mean pulmonary artery pressure (MPAP) above the median values of the cohort. Logistic regression was used to identify predictors of hemodynamic response. Results During the study period, 218 chronic systolic HF patients underwent IABP insertion for acute decompensation with CS. The mean age was 59.4 ±13.4 years, 79.8% were men, and 38.5% had ischemic cardiomyopathy (ICM). The average hemodynamic response to IABP in the whole cohort was a CO increase of 0.57 ±0.85L/min and a MPAP reduction of 5.1 ±7.6mmHg; IABP-responders had a CO increase of 1.21 ±0.87L/min and a MPAP reduction of 12.1 ±5.9mmHg (figure). Univariable predictors of IABP-response were ICM, presence of severe mitral regurgitation, baseline heart rate, elevated MPAP, and elevated systemic vascular resistance (SVR). Following multivariable logistic regression, independent predictors of IABP-response were elevated baseline SVR (OR 2.05, 95% CI 1.01 - 4.17; p=0.047) and elevated MPAP (OR 2.47, 95% CI 1.23 - 5.00; p=0.01). MPAP reduction decreased the odds of death or need for escalation to another short-term circulatory support device while CO increase did not [OR 0.52 (0.28 - 0.97; p=0.04) vs. 0.83 (0.45 - 1.54; p=0.56)]. Conclusions A subset of chronic systolic HF patients had a robust hemodynamic response to IABP insertion with CO augmentation and MPAP reduction. Elevated baseline SVR and MPAP are predictors of robust response following device insertion. These parameters may be used to identify patients who may respond favorably to IABP counterpulsation therapy.

Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry.

To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96). There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58). In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.

Blood Pressure Monitoring During Intra-Aortic Balloon Pumping.

Blood Pressure Monitoring During Intra-Aortic Balloon Pumping.

A CFD investigation of intra-aortic balloon pump assist ratio effects on aortic hemodynamics

Intra-aortic balloon pump (IABP) is a mechanical circulatory support approach used in case of several cardiac diseases and a challenge of IABP therapy is the weaning process accomplished by decreasing the assist ratio. However, the impact of weaning on aortic hemodynamics on organs perfusions is not well known.Aim of this study was to evaluate and compare the global effects of IABP assistance frequencies on hemodynamics and perfusions in a patient-specific geometry by means of the computational fluid dynamics (CFD). A 3D aorta model was obtained from CT images using segmentation and reverse engineering techniques. The balloon was modeled and positioned in the descending aorta as in clinical practice and its inflation/deflation behavior was realized with a parametric study. Four assist ratios have been investigated: full assistance (1:1), partial assistances (1:2 and 1:3) and weak assistance (1:4). To perform the comparison, same boundary conditions were applied.Our results highlighted that the presence of balloon in aorta modifies significantly its hemodynamics and that the four assist ratios generate different perfusions in the human districts. Data suggested also that the biggest difference occurs between 1:2 and 1:3 frequencies and that 1:4 ratio is more suitable for the weaning of counterpulsation treatment than the 1:3 ratio.This first CFD analysis of IABP weaning increases information and knowledge on hemodynamics and organs perfusions.

Perioperative use of the intra-aortic balloon pump

Intraaortic balloon pump (IABP) has been the most widely used device to help patients recover from circulatory disorder mainly because of cardiogenic shock; however, no evidence-based clinical benefit derived from IABP support has been reported in recent clinical trials. This review provides an overview of the current outcomes and challenges in perioperative IABP use for cardiogenic shock patients. Although IABP support yielded no significant difference in mortality for myocardial infarction complicated by cardiogenic shock, perioperative IABP use generated beneficial clinical outcomes for high-risk patients undergoing coronary revascularization. The latest technology such as optical fiber sensor incorporated into the devices provides some beneficial effects on hemodynamics and reduces device-related complications. Perioperative IABP use is reasonable for cardiogenic shock patients as a bridge to further surgical intervention, to wean from cardiopulmonary bypass, and to postoperative recovery. Over the next years, a revolutionary technology will overcome the currently limited IABP therapy. Larger and longer term clinical investigations are also required to identify ideal patients for IABP use and to establish the position of IABP therapy.

Unique Complications Associated with Patient Ambulation in the Setting of Percutaneous Axillary Intra-Aortic Balloon Pump

Introduction We had previously published a percutaneous technique of axillary intra-aortic balloon pump (IABP) placement in patients being bridged to transplant for facilitation of ambulation and physical recovery. However, this enhanced mobility of the patient may predispose to a higher risk of IABP malposition with unique complications compared to the non-ambulatory state of femoral IABP therapy. We present our experience to illustrate this. Methods We conducted a retrospective chart review of patients that received percutaneous axillary IABP at our hospital from October 2015 to February 2018. Results A total of 75 patients had percutaneous axillary IABP insertion during the study period. Of these, 2 had gross IABP malposition into the arch of aorta and 5 patients had superior mesenteric artery (SMA) occlusion by IABP. Table 1 describes the specifics of these patients. Conclusion There has been a wealth of experience with femoral IABP use wherein the malpositions described above have not been reported. As utilization of IABP in the axillary position to promote ambulation is increasing, it is imperative to understand and expect such unique complications for prompt diagnosis and management.

Preoperative intraaortic balloon pump before urgent coronary bypass grafting.

Background Urgent or emergency coronary artery bypass grafting in patients with acute coronary syndrome is associated with increased morbidity and mortality. We investigated the effects of preoperative intraaortic balloon pump support in this high-risk patient cohort. Methods Our institutional database was retrospectively reviewed for patients with acute coronary syndrome and an urgent or emergency indication for coronary artery bypass from April 2010 to December 2016. Data of 1066 patients were analyzed. We assessed the impact of preoperative intraaortic balloon pump therapy on postoperative mortality and major adverse cardiovascular and cerebrovascular events, and performed propensity-score matching. Results Intraaortic balloon pump support was implemented in 223 (20.9%) patients: 55 (5.2%) preoperatively and 168 (15.8%) intra- or postoperatively. Overall hospital mortality was 8.8%. Patients with a preoperative intraaortic balloon pump had increased mortality (11/55, 20%) compared to controls ( p = 0.006). After propensity-score matching, all-cause mortality (20.0% vs. 18.2%, p = 0.834), cardiac mortality (18.2% vs. 14.5%, p = 0.651), and major adverse cardiovascular and cerebrovascular events (29.1% vs. 27.3%, p = 0.855) were comparable between groups. Conclusions Preoperative intraaortic balloon pump support does not confer any additional clinical benefit on patients undergoing coronary artery bypass grafting for acute coronary syndrome.

Clinical and hemodynamic effects of intra-aortic balloon pump therapy in chronic heart failure patients with cardiogenic shock.

The role of the intra-aortic balloon pump (IABP) in acute decompensated heart failure (HF) with cardiogenic shock (CS) is largely undefined. In this study we sought to assess the hemodynamic and clinical response to IABP in chronic HF patients with CS and identify predictors of response to this device. We retrospectively reviewed all patients undergoing IABP implantation from 2011 to 2016 at our institution to identify chronic HF patients with acute decompensation and CS (cardiac index <2.2 liters/min/m2 and systolic blood pressure <90 mm Hg or need for vasoactive medications to maintain this level). Clinical deterioration on IABP was defined as failure to bridge to either discharge on medical therapy or durable heart replacement therapy (HRT; durable left ventricular assist device or heart transplant) with IABP alone. We identified 132 chronic HF patients with IABP placed after decompensation with hemodynamic evidence of CS. Overall 30-day survival was 84.1%, and 78.0% of patients were successfully bridged to HRT or discharge without need for escalation of device support. The complication rate during IABP support was 2.3%. Multivariable analysis identified ischemic cardiomyopathy (odds ratio [OR] 3.24, 95% confidence interval [CI] 1.16 to 9.06; p = 0.03) and pulmonary artery pulsatility index (PAPi) <2.0 (OR 5.04, 95% CI 1.86 to 13.63; p = 0.001) as predictors of clinical deterioration on IABP. Overall outcomes with IABP in acute decompensated chronic HF patients are encouraging, and IABP is a reasonable first-line device for chronic HF patients with CS. Baseline right ventricular function, as measured by PAPi, is a major predictor of outcomes with IABP in this population.