Use Of Intra-aortic Counterpulsation Research Articles

Impact on intra-aortic balloon pump placement technique on cardiac surgical patient outcomes

Introduction Although the use of intra-aortic counterpulsation in cardiogenic shock was recently debated¹, it remains widely used device for the treatment of cardiac failure. The aim of our study was to evaluate intra-aortic balloon pump (IABP) placement technique related morbidity in cardiac surgical patient population. Methods Single center retrospective review of 424 cardiac surgical patients treated with intra-aortic counter-pulsation between January 1, 2013 and April 30, 2019 in a tertiary care center. Patient outcomes, procedure related morbidity and IABP insertion technical characteristics were evaluated (elective vs urgent, sheathed vs sheathless, ideal balloon tip position vs malposition). According to tip position patients were divided into three groups: good (at T2-T4 vertebrae), malposition (T5-T6), severe malposition (at T7 or below). Results Median patient age was 67 [Interquartile range (IQR), 59 to 75 years], 307 (72.4%) were male. Median EuroSCORE II was 4.4 [IQR, 2.4 to 10.5], median LVEF was 35 [IQR, 28 to 50]. Indications for IABP treatment were: cardiac failure or angina treatment before surgery in 45 (10.6%) patients, prophylactic use in high risk 178 (42.0%) patients, hemodynamically unstable before CPB in 5 (1.2%), hemodynamically unstable during off-pump CABG in 11 (2.6%), facilitate weaning from CPB in 47 patients (11.1%) low cardiac output following surgery in 137 (32.3%), weaning from ECMO in 1 (0.2%). Three hundred forty nine patients (82.3 %) survived to hospital discharge. In-hospital mortality was 5.1% in elective IABP placement group vs 26.8% in urgent IABP implementation group (p Discussion Elective balloon placement was associated with lower morbidity in cardiac surgical patients. Sheathed insertion showed a tendency of higher rate of vascular complications. Suboptimal IABP tip position was not associated with adverse outcome.

Intraaortic Balloon Pump Counterpulsation and Cerebral Autoregulation: an observational study

BackgroundThe use of Intra-aortic counterpulsation is a well established supportive therapy for patients in cardiac failure or after cardiac surgery. Blood pressure variations induced by counterpulsation are transmitted to the cerebral arteries, challenging cerebral autoregulatory mechanisms in order to maintain a stable cerebral blood flow. This study aims to assess the effects on cerebral autoregulation and variability of cerebral blood flow due to intra-aortic balloon pump and inflation ratio weaning.MethodsCerebral blood flow was measured using transcranial Doppler, in a convenience sample of twenty patients requiring balloon counterpulsation for refractory cardiogenic shock (N = 7) or a single inotrope to maintain mean arterial pressure following an elective placement of an intra-aortic balloon pump for cardiac surgery (N = 13). Simultaneous blood pressure at the aortic root was recorded via the intra-aortic balloon pump. Cerebral blood flow velocities were recorded for six minute intervals at a 1:1 balloon inflation-ratio (augmentation of all cardiac beats) and during progressive reductions of the inflation-ratio to 1:3 (augmentation of one every third cardiac beat). Real time comparisons of peak cerebral blood flow velocities with systolic blood pressure were performed using cross-correlation analysis. The primary endpoint was assessment of cerebral autoregulation using the time delay between the peak signals for cerebral blood flow velocity and systolic blood pressure, according to established criteria. The variability of cerebral blood flow was also assessed using non-linear statistics.ResultsDuring the 1:1 inflation-ratio, the mean time delay between aortic blood pressure and cerebral blood flow was -0.016 seconds (95% CI: -0.023,-0.011); during 1:3 inflation-ratio mean time delay was significantly longer at -0.010 seconds (95% CI: -0.016, -0.004, P < 0.0001). Finally, upon return to a 1:1 inflation-ratio, time delays recovered to those measured at baseline. During inflation-ratio reduction, cerebral blood flow irregularities reduced over time, whilst cerebral blood flow variability at end-diastole decreased in patients with cardiogenic shock.ConclusionsWeaning counterpulsation from 1:1 to 1:3 inflation ratio leads to a progressive reduction in time delays between systolic blood pressure and peak cerebral blood flow velocities suggesting that although preserved, there is a significant delay in the establishment of cerebral autoregulatory mechanisms. In addition, cerebral blood flow irregularities (i.e. surrogate of flow adaptability) decrease and a loss of cerebral blood flow chaotic pattern occurs during the end-diastolic phase of each beat in patients with cardiogenic shock.

Clinical impact of the prophylactic use of intra-aortic counterpulsation in high-risk patients undergoing myocardial revascularization

The use of the intra-aortic balloon (IAB) has been well established in the clinical management of patients with problems such as refractory myocardial ischemia, cardiogenic shock, and difficulty in weaning from extracorporeal circulation (ECC). However, the literature lacks evidence supporting the 'prophylactic' use of the IAB in high-risk patients undergoing myocardial revascularization (MR).

Clinical impact of the prophylactic use of intra-aortic counterpulsation in high-risk patients undergoing myocardial revascularization

Clinical impact of the prophylactic use of intra-aortic counterpulsation in high-risk patients undergoing myocardial revascularization

The use of intraaortic balloon counterpulsation as an adjunct to reperfusion therapy in cardiogenic shock

Modern coronary care unit interventions have not reduced the high mortality rate associated with cardiogenic shock due to acute myocardial infarction. Results with thrombolytic therapy have also been disappointing because of poor infarct artery patency rates in a low coronary flow state. Percutaneous transluminal coronary angioplasty appears to be a beneficial intervention, but the technique is not available at most hospitals. Intraaortic balloon counterpulsation provides temporary hemodynamic and clinical improvement in the majority of patients with cardiogenic shock. The use of intraaortic counterpulsation to augment patency rates with thrombolytic therapy or to stabilize patients for transfer to a hospital with angioplasty services appears to be a promising strategy for hospitals without an interventional cardiac catheterization laboratory.

Circulatory Assistance with a Cardiac Allograft after Exclusion of the Canine Left Ventricle

Cardiogenic shock after myocardial infarction still carries a high mortality despite use of intraaortic counterpulsation and early surgical revascularization. An experimental canine model of left ventricular exclusion and circulation support was developed by closing the mitral valve and by interposing “in series” a cardiac allograft between pulmonary and systemic circulations. This preparation was able to support the recipient circulation after cardiopulmonary bypass in 25 animals. In 16 dogs the graft sustained life for from 1 to 32 days. It is hypothesized that such left ventricular assistance could be used to maintain the life of patients in cardiogenic shock after myocardial infarction. By providing maximal left ventricular decompression and improvement of the native coronary perfusion, this method may reverse the metabolic imbalance responsible for extension of the infarction, thereby salvaging muscle that is in jeopardy but still viable.