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PubMed1999

[Intraaortic counterpulsation balloon].

The pumping or counterpulsation with an intraaortic balloon is currently the most widely used circulatory support technique due to the fact that it fulfills a unique role in the treatment of patients suffering from serious cardiovascular problems. No medication currently available can combine the two basic effects of the Intraaortic Counterpulsation Balloon Pump: reduction of the left ventricle aftercharge and of the increased diastolic arterial pressure. Since this procedure is a vital support for these patients, this challenges nurses' abilities and performance; therefore, continuous monitoring is necessary along with am immediate evaluation of the signs or symptoms of a patient's clinical and hemodynamic state and a precocious detection of possible complications.

Electrocardiography↗

PubMed2001

Enhanced External Counterpulsation in Unrevascularizable Patients.

Enhanced external counterpulsation (EECP) is a noninvasive outpatient therapy for the treatment of chronic angina. EECP treatment produces an acute hemodynamic effect that is similar to that produced by the invasive intra-aortic balloon pump. Three sets of cuffs on the upper thigh, lower thigh, and calves of each leg are inflated with compressed air during the diastolic phase of the cardiac cycle and are deflated in early systole. This rapid inflation and deflation raises diastolic aortic pressure, increases coronary perfusion pressure, and provides improved afterload reduction and increased venous return with a subsequent increase in cardiac output. Enhanced external counterpulsation has been shown to provide long-term symptom relief in patients with ischemic heart disease in several case series, as well as in a randomized trial. Up to 80% of patients selected for treatment have a positive clinical response, and an associated objective improvement has been demonstrated by functional imaging in several case series. A treatment course consists of 35 1-hour sessions over a 7-week period and is generally well tolerated with a low risk of adverse events. Development and enhancement of collateral channels, as well as peripheral conditioning and neurohumoral effects, may play a role in providing symptomatic relief. Studies are ongoing to determine the mechanism of action and to further define subsets of patients who might benefit.

Journal Article↗

PubMedDate not supplied

[Intraaortic balloon counterpulsation in the treatment of perioperative cardiogenic shock-complicated myocardial infarction during aortocoronary bypass surgery].

The paper presents the results of use of intraaortic balloon counterpulsation (IABC) in complex therapy for cardiogemic shock in 31 patients with perioperative myocardial infarction (PMI) developed during aortocoronary bypass surgery under extracorporeal circulation (EC) and cold cardioplegia. The diagnosis of PMI was confirmed by the ECG data (the emergence of new Q waves) and by the high level of CPC-MB (more than 6%). IABC was performed, by using a Kontron M-7000 apparatus. The time elapsed from the onset of myocardial infarction to the start of IABC averaged 15.7 + 4.3 hours and the duration of the latter did 105 +/- 13 hours. IABC was initiated in 4 (12.9%) patients in the operating room before EC, in 20 (64.5%) during disconnection from EC, in 7 (22.6%) patients, who were unresponsive to pharmacological therapy, 6-26 hours after surgery. All the patients were divided into 2 groups: (1) 22 patients who had benefited from complex therapy using IABC; they were all successfully disconnected from the balloon pump; (2) 9 patients with refractory heart failure who had died during IABC. The latter has been shown to be one of the effective treatments of PMI and cardiogenic shock during aortocoronary bypass surgery, which achieves hemodynamic stabilization in 70.9% of cases. The results of complex therapy for cardiogenic shock depend on the site and extent of myocardial infarction. Lesions to the anterolateroposterior or anteroseptal area of the left ventricle belong to poor predictors. The outcomes of treatment are poor if there are significant hemodynamic disorders that require, besides cardiotonic agents, the administration of large doses of agents having a potent vasopressor effect (adrenaline and noradrenaline). Improvements in left ventricular pump function, cardiac output, and a significant reduction in the doses of sympathomimetics within the first 12 hours of IABC should be considered to be a good predictor. With the complex treatment of cardiogenic shock, by using counterpulsation after aortocoronary bypass surgery is 51.6%. The early initiation of IABC within 6 hours following the development of myocardial infarction allows mortality to be reduced.

Aged↗

PubMed1989

Intra-aortic balloon counterpulsation in high-risk cardiac patients undergoing noncardiac surgery.

Patients undergoing noncardiac general surgical procedures after coronary artery bypass surgery have reduced mortality compared with those operated on without prior revascularization. The urgency of the noncardiac procedure and the potential reconstructability of the coronary artery anatomy may mitigate against timely revascularization. We report the successful outcome of prophylactic intra-aortic balloon counterpulsation in three patients with coronary artery disease and impaired left ventricular function undergoing noncardiac surgical procedures. Intra-aortic balloon counterpulsation may provide myocardial protection in high-risk cardiac patients requiring noncardiac surgery initially. A review of the literature is discussed.

Aged↗

PubMedDate not supplied

[The effect of intra-aortic balloon counterpulsation on the metabolism of the heart in acute cardiac insufficiency].

Myocardial metabolism has been experimentally studied in acute heart failure caused by the ligation of the left coronary artery branches and during intraaortic balloon counterpulsation. It has been shown that experimental acute heart failure and developing cardiogenic shock are accompanied by progressive deterioration in myocardial energy supply with predominant anaerobic metabolism. In intraaortic balloon counterpulsation and sufficient O2 supply of the myocardium nonesterified fatty acids are primarily metabolized. With the decrease in O2 consumption the proportion of energy-preserving metabolites, i.e. carbohydrates, is increased.

Animals↗

PubMed1987

Characteristic of patients surviving over a long-term period after intra-aortic balloon counterpulsation treatment.

Control examination of 21 patients after cardiac surgery which required the application of intra-aortic balloon counterpulsation in order to terminate extracorporeal circulation showed that, in spite of the serious postoperative course, the prognosis and quality of their life is a good one. Objective signs of left ventricular function show rather a moderate deterioration. Patients after myocardial revascularization have at the same time a demonstrable ischaemic disease of the lower extremities. Changes of more serious nature on the arteries of the lower extremities in connection with the earlier application of intra-aortic balloon counterpulsation could not be documented.

Adult↗

PubMed1987

Intraaortic balloon counterpulsation and coronary angioplasty in high risk coronary heart patients.

Fifteen patients with severely damaged coronary circulation required temporary intraaortic balloon counterpulsation for pharmacologically uncontrollable chest pain and poor haemodynamic state (hypotension or shock) in connection with the transluminal coronary angioplasty procedure. Twenty-five angioplasties were attempted (1.75 artery stem/patient) with a primary success rate of 96%. Emergency surgery was performed only once (6.6%) and no death occurred after the percutaneous therapeutic procedures. One patient died due to a cerebrovascular accident, two other patients suffered sudden death 1 and 3 months later. Two patients finally required coronary bypass surgery, and one patient a repeated angioplasty. In the follow-up period (mean = 11 months), two patients presented moderate symptoms of stable angina pectoris, and 10 patients (83%) remained in satisfactory condition. Temporary diastolic counterpulsation provided in patients with pharmacologically refractory myocardial ischaemia and hypotension or shock an important protection for performing transluminal angioplasty in a good condition, with improved remaining coronary circulation and haemodynamic state, assuring a favourable hospital survival.

Adult↗

PubMed1987

[Refractory unstable angina. Emergency treatment by coronary artery angioplasty under aortic counterpulsion].

We report our experience of 15 transluminal coronary angioplasties performed in an emergency in 13 patients (mean age 67 +/- 8 years) with refractory unstable angina. The procedures were conducted under diastolic counterpulsation effected by means of an intra-aortic balloon. The angina was of the threatening infarction type on 11 occasions and of the threatening extended infarction on 4 occasions. Electrocardiographic abnormalities were recorded in the anterior (11 cases) or in the inferior (4 cases) territory. Three patients had a very alarming haemodynamic status, with acute pulmonary oedema in two and cardiogenic shock in one. After intra-aortic counterpulsation was installed and the clinical signs were stabilized, coronaro-ventriculography was performed, leading to a decision of immediate angioplasty since age, underlying diseases, myocardial function and diffused lesions made most of the patients unsuitable for surgery. In multiple vessel patients electric and angiographic data were used to locate the tight stenosis (92% in all cases) responsible for the acute coronary ischaemia. The stenosis was found to affect the anterior interventricular artery in 9 cases, the circumflex artery in 2 cases, the right coronary artery in 2 cases and a saphenous shunt on the anterior interventricular artery in 2 cases. Immediate arteriographic and clinical success was obtained in 12 out of 15 cases (80%); there were 3 failures with 2 transmural infarctions. Later on, 2 patients underwent aorto-coronary bypass and 1 died of myocardial failure and pulmonary superinfection 3 weeks after the procedure. Ten of our 13 patients were stabilized and were discharged under medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1978

Experience with intra-aortic balloon counterpulsation in a community hospital.

Intra-aortic balloon counterpulsation is well established as an adjunct in the treatment of refractory cardiac failure in university centers. We have analyzed the practicality of its use at a community hospital without cardiovascular resident coverage. Between 1971 and 1976, 27 patients were subjected to counterpulsation. The survival rate was 44%. This compares well with university centers where various reports listed survival rates between 14% and 50%. We believe that IABP is a valuable adjunct in the total care of cardiac patients and should be used in all community hospitals in which cardiac surgery is done.

Aged↗

PubMed1981

Therapeutic efficacy of intraaortic balloon pump counterpulsation. Analysis with concurrent "control" subjects.

During a 7-year period, intraaortic balloon pumping (IABP) was attempted in 319 cardiac surgical patients. The indications for IABP were stringent and consisted of unsuccessful discontinuation of cardiopulmonary bypass (39%), anticipated failure (40%) to wean from cardiopulmonary bypass, postoperative low cardiac output, or intractable ventricular tachyarrhythmias (15%). IABP support was successfully instituted in 280 patients and was unsuccessful in 39 patients ("controls"). These two groups were comparable except for an older mean age and a higher ejection fraction in controls. Operative mortality rates were 45% and 62% for IABP and control groups, respectively (p = 0.077). This difference was most evident in coronary artery bypass patients, in whom the decision to institute IABP counterpulsation was made intraoperatively before attempted discontinuation of cardiopulmonary bypass. Two years postoperatively the actuarial survival rate was 45 +/- 3% for the IABP group and 23 +/- 9% for the control group (p = 0.006). After exclusion of operative deaths, however, these survival rates were 81 +/- 3% and 60 +/- 20%, respectively (p = NS). The average hospital charge incurred by IABP patients was threefold greater than that of uncomplicated cardiac surgical procedures. We conclude that IABP counterpulsation is therapeutic for some cardiac surgical patients, but its benefits cannot be defined easily. The long-term survival rates for patients with advanced disease requiring IABP support perioperatively are poor and warrant continued development of more effective methods of mechanical circulatory assistance and heart replacement.

Assisted Circulation↗

PubMed1982

Intraaortic balloon counterpulsation in acute myocardial infarction.

Intraaortic balloon counterpulsation was undertaken in 24 patients with acute myocardial infarction. The patients were divided into four groups: severe left ventricular dysfunction (11 patients), mechanical lesions (6), intractable angina pectoris (6) and refractory ventricular tachycardia (1). The clinical condition and the hemodynamic measurements improved dramatically in 21 patients, but there were only 9 long-term survivors. Intraaortic balloon counterpulsation gave the best results in patients with preinfarction angina pectoris or patients with left ventricular dysfunction where the hemodynamic status deteriorated after an acute but reversible cardiovascular event. Numerous local complications were observed.

Adult↗

PubMed1981

Intra-aortic balloon counterpulsation as adjunct to aneurysmectomy in high-risk patients.

Patients with severe coronary artery disease that is not amenable to coronary artery bypass surgery face formidable risks when major aortic surgery becomes necessary. In this report we present such a patient, who successfully underwent abdominal aortic aneurysm resection and graft replacement with the prophylactic use of intra-aortic balloon counterpulsation. The use of intra-aortic balloon counterpulsation at the time of surgery has the potential of improving cardiac function in patients with left ventricular dysfunction and favorably influencing the perioperative and postoperative mortality in these patients. Its use also appears worthy of trial in patients with ruptured abdominal aortic aneurysm and shock, in the hope that it will result in improved survival in these patients.

Aorta, Abdominal↗

PubMedDate not supplied

Effect of balloon counterpulsation on myocardial ischemia as measured by intramyocardial carbon dioxide tension.

Ischemic injury of the heart following coronary artery occlusion is related to distribution of coronary blood flow and regional myocardial metabolic activity. Myocardial injury during regional ischemia has been studied by measuring tissue pCO2 with mass spectrometry, a parameter which reflects anaerobic cellular metabolism. Myocardial carbon dioxide tension has been used to evaluate the effect of unidirectional intra-aortic balloon pumping on ischemic injury resulting from acute coronary occlusion. In a group of ten dogs, balloon counterpulsation was begun immediately prior to left anterior descending coronary artery occlusion. A significant metabolic sparing effect was observed in counterpulsed dogs as compared to a control group. A decrease of 33% in PCO2 response was evident as compared to control. These results that early application of unidirectional intra-aortic balloon pumping may delay ischemic injury by improving regional oxygen supply/demand ratio to an area of acute ischemia.

Acute Disease↗

PubMed1993

Management of intraoperative right ventricular failure with pulmonary artery balloon counterpulsation.

There are many etiologic factors that contribute to the development of right ventricular failure. However, the clinical manifestations and treatment modalities parallel whether the causative factor is from intraoperative complications or cardiovascular pathology. When adequate preload and pharmacologic support fail to enhance right ventricular function, the placement of a pulmonary artery balloon catheter for counterpulsation may be required. Currently, the pulmonary artery balloon catheter requires intraoperative placement. However, further research and refinements may allow peripheral placement of the catheter, using a smaller sized balloon. A case study is presented of a patient requiring intraaortic and pulmonary artery balloon counterpulsation for intraoperative right ventricular failure, after a mitral valve replacement.

Adult↗

PubMed2026

Combined Effects of Nicorandil and Enhanced External Counterpulsation on Coronary Microcirculation and Exercise Capacity in Patients With Coronary Slow Flow Phenomenon: A Randomized, Controlled, 3-Arm Trial.

PURPOSE: To evaluate the combined efficacy and safety of combined nicorandil and enhanced external counterpulsation (EECP) therapy compared with respective monotherapies in patients with coronary slow flow phenomenon (CSFP). METHODS: In this prospective, randomized, 3-arm clinical trial, 309 patients with angiographically defined CSFP based on corrected TIMI frame count were assigned (1:1:1) to the Nicorandil group (N group, n = 103), the EECP group (E group, n = 103), or the Combined therapy group (N+E group, n = 103). The trial was prospectively registered at ClinicalTrials.gov (NCT07534410). IMR and CFR were measured to characterize coronary microvascular physiological status and treatment response. The primary endpoint was corrected TFC at 6 months. Key secondary endpoints included invasive physiological indices (IMR and CFR), Seattle Angina Questionnaire scores, 6-minute walk test (6MWT) distance, peak oxygen uptake via cardiopulmonary exercise testing, and the 12-month rate of re-hospitalization due to recurrent angina. FINDINGS: At 6 months, the N+E group demonstrated superior improvement in coronary hemodynamics compared to the N and E monotherapy groups, with significantly lower TFC (30.4 ± 3.5 vs 38.2 ± 3.8 and 37.5 ± 4.0, respectively; P < 0.001) and IMR (21.2 ± 2.8 vs 28.4 ± 3.2 and 27.6 ± 3.5, respectively; P < 0.001). Clinical symptoms and functional capacity showed the most substantial gains in the N+E group, with significantly higher Seattle Angina Questionnaire angina frequency scores (87.5 ± 8.8) and 6MWT distances (506.8 ± 41.8 m) compared to monotherapy groups (all P < 0.001). Furthermore, peak oxygen uptake in the N+E group increased to 23.5 ± 2.6 mL/kg/min, significantly outperforming the N and E groups (P < 0.001). During the 12-month follow-up, the observed rate of re-hospitalization due to recurrent angina was lower in the N+E group (5.8%) than in the N group (17.5%, P = 0.017), although this clinical outcome should be interpreted cautiously because the trial was powered primarily for physiological endpoints. No significant differences were observed in the incidence of adverse reactions among the 3 groups (P = 0.954). IMPLICATIONS: For patients with CSFP, the combination of Nicorandil and EECP improved coronary microvascular function, anginal symptoms, and objective exercise tolerance more effectively than either active monotherapy. The lower observed rate of angina-related re-hospitalization suggests a potential clinical benefit, but this finding should be considered exploratory and requires confirmation in trials adequately powered for clinical outcomes.

Humans↗

PubMed2001

Intra-aortic counterpulsation during carotid stenting.

Postprocedural hypotension following endovascular stent placement of carotid artery disease (CAS) predicts increased in-hospital complications and long-term risk of death. Intra-aortic balloon counterpulsation (IABP) both increases mean arterial pressure and cerebral blood flow and therefore possibly reduces complications due to hemodynamic instability during and after CAS. In this study, we describe the use of IABP in a patient with severe depression of left ventricular function due to diffuse coronary artery disease undergoing CAS. Controlled studies are necessary to demonstrate a potentially protective role of IABP in high-risk CAS patients.

Aorta↗

PubMed2003

Exercise capability and myocardial perfusion in chronic angina patients treated with enhanced external counterpulsation.

BACKGROUND: Enhanced external counterpulsation (EECP) has been shown to improve treadmill times and myocardial perfusion. However, improvement in perfusion defects has been demonstrated only in patients exercised to the same cardiac workload on the post-EECP as the pre-EECP stress test. HYPOTHESIS: This study was to determine the effect of EECP on exercise capacity and myocardial perfusion by comparing results of maximal exercise radionuclide testing pre- and post-EECP treatment. METHODS: This prospective study included 25 patients with angina who had performed maximal symptom-limited exercise tolerance tests (ETT) with Bruce protocol and radionuclide perfusion single-photon emission computed tomography (SPECT) study prior to and at completion of EECP treatment. RESULTS: After 35 h of EECP, 23 patients (93%) improved by at least one functional angina class. There is a significant improvement in their total treadmill times (357 +/- 93 to 449 +/- 97 s, p < 0.001). There was a significant change in their peak double products, from 18,891 +/- 3,939 pre-EECP to 20,464 +/- 4,305 post-EECP ETT (p < 0.03). Pre EECP, 16 patients had ST-segment depression on their initial ETT. After EECP, 13 of these patients (80%) either no longer had ST depression or had a significant increase in their time to ST depression (229 +/- 52 to 315 +/- 60 s, p < 0.001). The radionuclide perfusion scores also showed a significant reduction in ischemic segments (16.36 +/- 10.52 to 14 +/- 10.9, p < 0.05). CONCLUSIONS: Patients treated with EECP demonstrated a reduction in angina symptoms, improvement in exercise capacity, increase in time to ST-segment depression, and decrease in perfusion defects despite performing at a higher workload.

Aged↗

PubMed1997

Enhanced external counterpulsation as an adjunct to revascularization in unstable angina.

Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for chronic stable angina. Despite intensive risk factor modification, a patient required two surgical coronary revascularizations and seven multivessel angioplasties over a 26-month period, demonstrating recurrent unstable angina and persistent thallium perfusion defects despite revascularization. Post EECP, angina was relieved, thallium defects were resolved and the patient has remained asymptomatic for 36 months.

Angina, Unstable↗