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PubMedDate not supplied

Chronic counterpulsation with descending thoracic aortomyoplasty improved cardiac function in animals with heart failure.

Descending thoracic aortomyoplasty uses latissimus dorsi muscle for extraaortic diastolic counterpulsation. We hypothesized that descending thoracic aortomyoplasty could improve ventricular function in dogs (n = 5) with heart failure. The left latissimus dorsi muscle was wrapped around the descending aorta and conditioned for 4 weeks with a burst stimulator (five pulses, 33 Hz, 28 bursts/min). Heart failure was induced by rapid ventricular pacing after conditioning. Left ventricular volume was measured with a conductance catheter. Left ventricular and aortic pressures were measured with a micromanometer. Mean diastolic blood pressure, endocardial viability ratio, left ventricular peak pressure, left ventricular end-diastolic pressure, stroke work, isovolumic relaxation time constant, and the end-systolic pressure volume relation were measured at baseline (after heart failure) and with the descending thoracic aortomyoplasty stimulated at 1:1. Contraction of the descending thoracic aortomyoplasty augmented mean diastolic blood pressure (62 +/- 4 to 71 +/- 3 mm Hg) and endocardial viability ratio (1.0 +/- 0.30 to 1.5 +/- 0.13) (p < 0.05). Left ventricular peak pressure (98 +/- 4 to 88 +/- 3 mm Hg), left ventricular end-diastolic pressure (19 +/- 4 to 14 +/- 4 mm Hg), and stroke work (1048 +/- 124 to 743 +/- 80 mm Hg.cm3) (p < 0.05) were reduced. The end-systolic pressure volume relation increased with descending thoracic aortomyoplasty stimulation (3.7 +/- 0.7 to 4.5 +/- 0.8 mm Hg/mL), and the isovolumic diastolic relaxation time constant significantly decreased (54 +/- 6 to 49 +/- 7 msec) (p < 0.05). We conclude that descending thoracic aortomyoplasty can provide diastolic counterpulsation and reduce stroke work in animals with heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Current concepts in the use of intra-aortic balloon counterpulsation.

Mechanical support of the circulation using intra-aortic balloon counterpulsation has thus far largely been confined to cardiac units. With improved techniques of insertion, many critically ill patients may now benefit. This article reviews the physiology of counterpulsation, the indications and contraindications for its use, and the complications that may occur.

Cardiac Output, Low↗

PubMed1993

[32 cases of sudden deafness treated with sequential external counterpulsation in addition to combined traditional Chinese medicine and Western medicine therapy].

The present study includes 32 cases of sudden deafness treated with Sequential External Counterpulsation in addition to combined TCM-WM therapy, 30 cases treated with combined TCM-WM, and 30 cases treated with WM alone. The clinical findings of these 3 groups were quite similar, hence they were comparable. The mean duration of treatment, percentage of effectiveness and percentage of recurrence within 3 years were 13 days, 75% and 16.6% respectively in the first group; 19 days, 56.6% and 29.4% in the second group; and 21 days, 53.2% and 37.5% in the third group. The first group showed shorter duration of treatment higher effective rate and lower recurrence rate; and all their differences were statistically significant (P < 0.05). The data revealed that, the treatment of sudden deafness with Sequential External Counterpulsation in addition to combined TCM-WM has great advantage over treatment with combined TCM-WM or WM alone.

Adenosine Triphosphate↗

PubMed1995

[Assisted circulation to the right ventricle through pulmonary counterpulsation using a biological method].

PURPOSE: To study the hemodynamic effects of latissimus dorsi dynamic pulmonaroplasty in open chest animals. METHODS: Six anesthetized mongrel dogs were subjected to diastolic counterpulsation using electrically stimulated latissimus dorsi muscle flap wrapped around the aortic and pulmonary arteries roots and gated to the surface electrocardiogram. Aortic and Pulmonanary pressures as well as cardiac output and cardiac index were measured. RESULTS: Diastolic counterpulsation resulted in a significant increase in cardiac output (from 2.35 +/- 0.26 to 2.45 +/- 0.28 l/min) (p < 0.005) and cardiac index (from 0.108 +/- 0.020 to 0.113 +/- 0.020 l/min/kg) (p < 0.05). The diastolic pulmonary arterial efficiency index showed a significant increase when latissimus dorsi stimulation was on (from 8.37 +/- 0.60 to 11.65 +/- 0.83 mmHg); (p < 0.005). CONCLUSION: Latissimus dorsi dynamic pulmonaroplasty provides an effective means of arterial counter pulsation in open chest dogs.

Animals↗

PubMed2005

Thrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial.

BACKGROUND: Sustained hypotension, cardiogenic shock, and heart failure all imply a poor prognosis in acute myocardial infarction (MI). We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation (IABP) to standard treatment for MI, in an international trial among hospitals without primary angioplasty capabilities. METHODS: We randomized 57 patients with MI complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure to receive either fibrinolytic therapy and IABP or fibrinolysis alone. The primary end point was all-cause mortality at 6 months. RESULTS: In all, IABP was inserted in 27 of 30 assigned patients a median 30 minutes after fibrinolysis began and continued for a median 34 hours. Of the 27 patients assigned to fibrinolysis alone, 9 deteriorated such that IABP was required. The IABP group was at slightly higher risk at baseline, but the incidence of the primary end point did not differ significantly between groups (34% for combined treatment versus 43% for fibrinolysis alone; adjusted P = 0.23). Patients with Killip class III or IV showed a trend toward greater benefit from IABP (6-month mortality 39% for combined therapy versus 80% for fibrinolysis alone; P = 0.05). CONCLUSIONS: While early IABP use was not associated with a definitive survival benefit when added to fibrinolysis for patients with MI and hemodynamic compromise in this small trial, its use suggested a possible benefit for patients with the most severe heart failure or hypotension. ABBREVIATED ABSTRACT: We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation to fibrinolytic therapy among 57 patients with acute myocardial infarction complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure. The primary end point, mortality at 6 months, did not differ between groups (34% for combined treatment versus 43% for fibrinolysis alone [n = 27]; adjusted P = 0.23), although patients with Killip class III or IV did show a trend toward greater benefit from IABP (39% for combined therapy versus 80% for fibrinolysis; P = 0.05).

Aged↗

PubMed1983

The role of intra-aortic balloon counterpulsation in patients undergoing percutaneous transluminal coronary angioplasty.

Between June, 1979, and July, 1982, 14 patients required an IABP in conjunction with PTCA. The clinical indications for balloon counterpulsation, in the performance of PTCA were (1) clinically unstable situations where PTCA might otherwise be contraindicated, e.g., left main stem disease, multivessel coronary artery disease, unstable anginal syndromes, and cardiogenic shock; (2) preoperative insertion of an IABP for added safety following unsuccessful angioplasty; (3) abrupt vessel closure during a PTCA procedure in which the patient becomes hemodynamically unstable; and (4) late vessel closure following an initially successful angioplasty resulting in hemodynamic compromise. Of the 14 cases requiring balloon counterpulsation, 13 survived hospitalization and were alive at the time this report was submitted. We conclude that IABP is a useful adjunct to PTCA in a variety of clinical circumstances.

Adult↗

PubMed1975

Intraaortic balloon counterpulsation in patients in cardiogenic shock, medically refractory left ventricular failure and/or recurrent ventricular tachycardia.

Of the 27 patients described, 23 were in cardiogenic shock, 2 had severe left ventricular failure, and 2 had medically refractory ventricular tachycardia. Utilizing intraaortic counterpulsation, adequate systemic blood pressure was initially restored in 19 patients. Nine of these were subsequently weaned from circulatory assistance, but only three were discharged from the hospital and are currently alive. The remaining 10 patients who derived initial benefit from circulatory assistance were balloon-dependent in that they could not be weaned from circulatory assistance. Eight of these patients subsequently underwent cardiac catheterization; four had inoperable disease. The remaining four patients underwent surgery for either resection of the area of infarction and/or for myocardial revascularization; only one survived to subsequently leave the hospital. Ventricular volumes were abnormal and ejection fractions were below 30 per cent in all the patients in cardiogenic shock except one who underwent cardiac catheterization and ultimately died. Ejection fractions were greater than 30 per cent in the two patients with cardiogenic shock who were weaned from balloon support and survived to leave the hospital without surgery. Both of these patients had inferior myocardial infarction. The data obtained from this experience suggest that intraaortic counterpulsation is a very useful adjunct to currently existing medical measures to treat both cardiogenic shock and medically refractory left ventricular failure but that most patients have such extensive disease that they can neither be weaned from balloon support nor undergo successful infarctectomy or myocardial revascularization.

Adult↗

PubMed1987

Vascular complications of intraaortic balloon counterpulsation.

Between February 1973 and December 1986, 4,787 patients underwent open heart surgery at Samuel Merritt Hospital. Retrospective analysis revealed 395 (8 percent) consecutive patients who required hemodynamic support with the intraaortic balloon pump. Thirty percent of the patients had preoperative placement, 56 percent needed the balloon in order to wean from cardiopulmonary bypass, and 14 percent required placement in the postoperative period. The intraaortic balloon pump was instituted with multiple techniques and insertion sites. Three hundred eighty-three balloon catheters (96 percent) were inserted through the groin by surgical cutdown or a percutaneous approach. The remaining devices were inserted through the aortic arch. A 12 F. catheter was utilized in 239 patients (61 percent) and a smaller 10.5 F. catheter was placed in 156 patients (39 percent). The hospital mortality rate was 47 percent. Seventy-two of the 395 patients (24 percent) sustained vascular complications related to balloon use. Major complications occurred in 43 patients. Twenty-nine patients sustained minor complications that resolved spontaneously with balloon removal. Risk factors evaluated included patient gender, New York Heart Association class, catheter size, method of introduction, duration of counterpulsation, and presence of symptomatic peripheral vascular disease. Since percutaneous placement was associated with a significant decrease in complications, we concluded that use of the smaller 10.5 F. catheter placed percutaneously is the safest means of employing the intraaortic balloon pump. A monitoring line is placed percutaneously through the femoral artery in high-risk patients before operation. This allows easier access for intraaortic balloon pump placement in hypotensive patients. The presence of a clinical history of peripheral vascular disease was also a highly significant risk factor for vascular complications. Other risk factors increasing the likelihood of vascular compromise included catheter size and duration of counterpulsation.

Evaluation Studies as Topic↗

PubMed1996

Arterial impedance in patients during intraaortic balloon counterpulsation.

BACKGROUND: Symptomatic improvement of a patient's hemodynamic condition during intraaortic balloon counterpulsation (IABC) is considered to result largely from a reduction in afterload. Afterload can be accurately quantified by arterial input impedance measurements. Here we report the effect of IABC on arterial impedance in humans. METHODS: To characterize the effects of IABC on arterial input impedance, impedance measurements were obtained using aortic annulus Doppler flow and pressure from the aortic balloon catheter. Impedance spectra were compared between the cardiac cycles preceding and following the cycle with IABC in 25 patients. RESULTS: Intraaortic balloon counterpulsation increased stroke volume (23%; p = 0.001), reduced myocardial oxygen demand (11%; p = 0.02), and decreased the aortic pressure at the onset of systole (16%; p = 0.001). There was also a decrease in systemic vascular resistance (24%; p = 0.001), characteristic arterial impedance (21%; p = 0.002), and pulse wave reflection (20%; p = 0.006). Linear regression analysis showed that an increase in stroke volume was predicted only by the decrease in systemic vascular resistance (r = -0.81; p = 0.001). CONCLUSIONS: The reduction in systemic vascular resistance appeared to be the major mechanism by which IABC improved cardiac pumping efficiency. This effect may result from the passive distention of the peripheral vascular bed due to the propagation of the balloon-augmented diastolic pressure through the arterial system.

Aged↗

PubMed1988

The combined use of diastolic counterpulsation and coronary dilation in unstable angina due to multivessel disease under unstable hemodynamic conditions.

Sixteen patients with multivessel ischemic heart disease and severely jeopardized myocardium required intra-aortic balloon counterpulsation subsequent to a deterioration in hemodynamics during or following a coronary angioplasty procedure. They had all suffered unstable angina which was refractory to intensive medical therapy, consisting of a combination of nitroglycerin, beta-adrenergic antagonists, and calcium blockers. Thirty angioplasties had been attempted (1.9 artery stem/patient) with a primary success rate of 90%. The symptoms of prolonged myocardial ischemia had disappeared, and the patient's blood pressure had normalized. No complications were associated with the use of the mechanical circulatory assistance. There were no deaths related to the procedure itself, and no myocardial infarctions. Emergency surgery was not required. One patient did die in hospital, however, due to cerebrovascular accident which occurred 4 days after removal of the mechanical circulatory support. Two also died suddenly later. One patient also required later elective coronary arterial bypass surgery and another needed repeated coronary dilation. The 12 remaining patients are asymptomatic at a follow-up with mean value of 22 months. Temporary intra-aortic diastolic counterpulsation is a useful adjunct to coronary angioplasty in patients with multivessel unstable angina and compromised hemodynamics.

Adult↗

PubMed1993

The use of intra-aortic balloon counterpulsation in malignant ventricular arrhythmias.

We describe a patient with recurrent ventricular arrhythmias post anterior myocardial infarction who stabilised following intra-aortic balloon counterpulsation. Antiarrhythmic drugs and continuous ventricular pacing were ineffective. The possible mechanisms of the improvement with counterpulsation and other treatment options are discussed.

Anti-Arrhythmia Agents↗

PubMed2004

In-hospital mortality associated with the use of intra-aortic balloon counterpulsation.

We analyzed in-hospital mortality for patients treated with intra-aortic balloon counterpulsation from the Benchmark Counterpulsation Outcomes Registry (n = 25,136). In-hospital mortality was higher in patients who received only medical interventions (32.5%) than in those who underwent percutaneous (18.8%) and surgical (19.2%) interventions, and was greatest in the first days after hospital admission for all 3 intervention types. Therefore, diagnostic evaluation and treatment decisions should be made as early as possible, and physicians should be aware of associated risk factors in making choices for patients.

Aged↗

PubMed2003

Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark Registry.

AIMS: To examine differences in patient characteristics and outcomes in 19636 patients enrolled in the USA and 3027 patients enrolled in other countries undergoing intra-aortic balloon pump (IABP) counterpulsation. METHODS AND RESULTS: Indications for IABP use; a larger percentage of US patients were identified as 'early support and stabilization for angiography or angioplasty' (21.1% US vs 11.8% non-US), and 'pre-operative support for high-risk CABG' (15.9% vs 6.6%). A smaller percentage of US patients vs non-US patients were identified as 'weaning from cardiopulmonary bypass' (14.3% vs 28.2%), and 'refractory ventricular failure' (6.2% vs 9.8%). One out of five patients in both groups was listed as 'cardiogenic shock' (18.9% US vs 20.2% non-US). All cause, risk-adjusted, in-hospital mortality (20.1% vs 28.7%; P<0.001), and mortality with IABP in place (10.8% vs 18.0%; P<0.001) were lower at US vs non-US sites. In both US and non-US institutions, IABP associated complication rates, such as IABP-related mortality (0.05% vs 0.07%), major limb ischaemia (0.9% vs 0.8%), and severe bleeding (0.9% vs 0.8%), were low. CONCLUSIONS: IABP counterpulsation is deployed at an earlier clinical stage in US patients. Mortality rates are higher for non-US patients, particularly for patients with non-surgery cardiac interventions, even after adjusting for risk factors. Complication rates were low. Physicians should therefore not be reluctant to use IABP in high-risk patients undergoing cardiac procedures.

Aged↗

PubMed2002

Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery.

BACKGROUND: As the proportion of high-risk patients for cardiac surgery increases, use of intraaortic balloon counterpulsation (IABC) has increased, especially in preoperative therapy. Although the efficacy and cost-effectiveness of IABC have been demonstrated, historically higher complication rates have dissuaded some practitioners from using IABC. METHODS: This report describes IABC use in cardiac surgery, examines trends in complications over time, and compares outcomes in preoperative versus postoperative use in a single prospective worldwide registry over the past 3 years. RESULTS: The frequency of IABC use appears to be increasing with time as the complication rates have dramatically fallen. The overall IABC-related complication rate was 6.5% (460/7,101), and the rate of major complications (requiring surgery or transfusion) was 2.1% (148/7,101). Hospital mortality was significantly lower in patients treated preoperatively with IABC compared with patients treated postoperatively (8.8% vs 28.2%, p < 0.0001), although this may be due to a selection bias in the postoperative group. CONCLUSIONS: Preoperative IABC therapy leads to better patient outcomes in high-risk CABG patients. Improved IABC technology and better surveillance have led to increased use with lower complication rates. Although selection bias is inherent in retrospective studies, the Benchmark Counterpulsation Outcomes Registry outcomes are in close concordance to prospective randomized studies previously reported.

Cardiac Surgical Procedures↗

PubMed1985

Pulmonary artery balloon counterpulsation for treatment of intraoperative right ventricular failure.

Pulmonary artery balloon counterpulsation was used in 3 patients who underwent open-heart operation for the treatment of acquired cardiac lesions. This form of support was initiated because the patients could not be weaned from cardiopulmonary bypass even with intraaortic balloon counterpulsation and maximal pharmacological support. After pulmonary artery balloon pumping was instituted, cardiopulmonary bypass was successfully terminated in all 3 patients. One of them is alive and well one year after operation.

Aged↗

PubMed1984

Pulmonary artery balloon counterpulsation for right ventricular failure: II. Clinical experience.

The use of pulmonary artery balloon counterpulsation (PABC) provided immediate salvage following cardiac surgical procedures in 2 patients with biventricular failure in whom inotropic drugs and intraaortic balloon counterpulsation did not provide sufficient support to allow weaning from cardiopulmonary bypass. Although both patients eventually died, the hemodynamic effectiveness of PABC was documented. The various clinical settings for right ventricular as well as biventricular failure are reviewed, the currently available options for treatment are summarized, and the directions for future laboratory investigation and possible clinical applications are presented.

Aged↗

PubMed1998

Influence of ascending versus descending balloon counterpulsation on bypass graft blood flow.

BACKGROUND: Mechanical circulatory assistance is frequently needed in postcardiotomy patients to support the failing heart. A balloon catheter called SupraCor (ABIOMED Cardiovascular, Inc, Danvers, MA) has been developed and is similar to the existing intraaortic balloon pump with the exception of placement in the ascending versus the descending thoracic aorta. This investigation compared the effects of SupraCor versus standard intraaortic balloon pump on internal mammary artery and venous conduit bypass graft blood flow. METHODS: Porcine total heart bypass was used to anastomose a jugular vein from the ascending aorta to a subsequently ligated left anterior descending coronary artery. The left internal mammary artery was then anastomosed to the jugular vein so each conduit perfused the same coronary vascular bed. An additional right heart bypass preparation allowed precise control of cardiac output and blood pressure, which were maintained constant throughout mechanical circulatory assistance. Electromagnetic flow probes measured flow through each bypass graft and the other conduit was atraumatically occluded. RESULTS: The SupraCor caused a significant increase in both internal mammary artery (+70% from 35 +/- mL/min to 56 +/- 9 mL/min; p = 0.04) and venous bypass graft blood flow (+49% from 66 +/- 12 mL/min to 95 +/- 15 mL/min; p = 0.02) when compared with controls. The intraaortic balloon pump failed to alter internal mammary artery or venous bypass graft flow. CONCLUSIONS: The results demonstrate that counterpulsation with an ascending aortic balloon significantly increases coronary bypass graft flow in both internal mammary artery and venous conduits. In contrast, counterpulsation with a descending aortic balloon did not alter coronary bypass graft flow.

Animals↗

PubMed1975

External counterpulsation in low cardiac output states.

External counterpulsation represents a rational extension of the basic principles of counterpulsation as developed over the past 20 years. Its unique properties of being totally noninvasive, free of significant morbidity, and easily and quickly instituted clinically suggest that it may have a significant therapeutic role in the prevention and treatment of cardiogenic shock following acute myocardial infarction as well as being helpful in other cardiac disorders. Continuing evaluation is necessary, and it should be thought of as one of several useful mechanical circulatory assist devices now available to the internist, cardiologist, and surgeon caring for the critically ill patient.

Angina Pectoris↗