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PubMed1992

[Current role of intra-aortic diastolic balloon counterpulsation in heart surgery].

Intra-aortic balloon counterpulsation (IABP) is a relatively non-invasive method of circulating assistance, easy to use and which has benefitted from a number of technological improvements in recent years. This retrospective study over 4 years was undertaken to analyse the results of IABP and to determine its role in therapeutic arsenal against cardiac failure. Sixty five patients, 57 coronary and 8 valvular cases, with an average age of 61 +/- 10 years were included. The indications of IABP were: a bridge to transplantation (3 cases), complications of coronary angioplasty (4 cases), and low cardiac output after cardiopulmonary bypass (58 cases), where IABP was curative in 85% of cases and prophylactic in 15% of cases (patients with risk factors of low output state after CPB). Beforehand, 65% of patients had poor left ventricular function (LVEF < 40% and/or CI < 2.2 l/mn/m2). An Aries Medical M700 console was used. The percutaneous femoral approach was feasible in 87% of cases. The results were: improvement with discharge from intensive care unit in 60% of cases, transient improvement in 7% of cases, no improvement in 15% of cases and cardiac transplantation in 8% of cases. The outcome was worse when the preoperative LV function was poor and when high dose inotropic agents had to be used. Survival was 100% in those patients in whom IABP was a prophylactic measure. The average duration of IABP was 72 hours, survival being significantly lower in those in whom IABP was continued for over 3 days. The complications (12.7%) were thromboembolic.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed2005

Microvessel angiogenesis: a possible cardioprotective mechanism of external counterpulsation for canine myocardial infarction.

BACKGROUND: Enhanced external counterpulsation (EECP) has been demonstrated to be effective in the treatment of patients with coronary artery disease (CAD). It has been proposed that the beneficial effects of EECP observed in clinical studies may be due to the formation of new blood vessels (angiogenesis) and collateral development. However, there is a relative paucity of basic studies to support the proposed mechanisms. METHODS: Twelve Beagle dogs were anesthetized with 3% sodium pentobarbital, 1 mg/kg intraperitoneal injection and mechanically ventilated for the development of myocardial infarction. After coronary occlusion, all animals were randomly assigned to either EECP or control. EECP was given one hour per day, 5 days a week, for a total of 28 to 30 hours treatment over a 6-week course. Immunohistochemical studies of alpha-actin and von Willebrand factor (vWF) were used to detect newly developed microvessels. Systemic and local vascular endothelial growth factor (VEGF) were identified by enzyme linked immunosorbent assay (ELISA) and reverse-transcriptional polymerase chain reaction (RT-PCR) analysis. RESULTS: There was a significant increase in the density of microvessels per mm(2) in the infarcted regions of EECP group compared to control group (vWF, 15.2 +/- 6.3 versus 4.9 +/- 2.1, P < 0.05; alpha-actin, 11.8 +/- 5.3 versus 3.4 +/- 1.2, P < 0.05), along with significant increase of positive vWF and alpha-actin stained area. Both immunohistochemical staining and RT-PCR analysis documented a significant increase in VEGF expression. These factors associated with angiogenesis corresponded to improved myocardial perfusion by 99mTc-sestamibi single-photon emission computed tomography. CONCLUSION: Microvessel angiogenesis may be a mechanism of action for the improved myocardial perfusion after EECP therapy.

Animals↗
PubMed2005

[Effect of chronic enhanced external counterpulsation on arterial endothelial cells of porcine with hypercholesteremia].

OBJECTIVE: To verify whether chronic enhanced external counterpulsation (EECP) may repair artery endothelial cells (ECs) damage resulted from hypercholesteremia in pigs. METHODS: EECP was performed for 36 hours in pigs with hypercholesteremia and the left descending artery (LDA) was isolated for scanning electron microscopy (SEM). The ECs were collected from the thoracic aorta and analyzed by proteomic technique. RESULTS: The ECs of hypercholesteremia pigs showed irregular arrangement with obvious desquamation of coronary ECs and formation of atherosclerotic plaque, and these lesions were milder in EECP-treated pigs. Six over-expressed proteins were detected in the endothelial cells in EECP-treated pigs in comparison with those of the hypercholesteremia pigs. CONCLUSION: Chronic EECP helps restore cell morphology and repair functional damage of ECs resulted from hypercholesteremia by regulating endothelial protein expressions, and consequently improves cell adhesion and intracellular metabolism and reduces EC apoptosis.

Animals↗
PubMed2006

[Effects of enhanced external counterpulsation in atherosclerosis and NF-kappaB expression: a pig model with hypercholesterolemia].

OBJECTIVE: To study the effects of enhanced external counterpulsation (EECP) on the vascular morphology, and endothelial function using experimentally induced hypercholesterolemic pigs. METHODS: Thirty five male pigs were randomly divided into three groups: 7 normal control animals, 11 hypercholesterolemic animals, and 17 hypercholesterolemic animals receiving EECP. Serum cholesterol was measured. The coronary arteries and aortas were sampled for histopathologic and ultrastructural examination. The NF-kappaB protein expression of porcine coronary arteries was investigated by immunofluorescence. RESULTS: Compared with the normal controls, serum cholesterol levels were significantly higher in the hypercholesterolemic animals with or without EECP. The plaque/intimal area ratio of the aorta decreased significantly in animals receiving EECP [(3.33 +/- 2.40)%, versus (12.03 +/- 7.12)% in those without EECP, P < 0.05]. Lipid deposition, endothelial damage and proliferation of smooth muscle cells were less severe in animals receiving EECP than those not. Moreover, activation and expression of NF-kappaB also decreased significantly (P < 0.05) in animals receiving EECP. CONCLUSIONS: EECP improves the morphology and function of vascular endothelium, and retards the development and progression of atherosclerosis, likely through the inhibition of NF-kappaB signaling pathway.

Animals↗
PubMed2006

[A study on noise controlling of the electromagnetic valve in external counterpulsation devices].

Noise of ECP (external counterpulsation) comes from the frequent movement of the electromagnetic valve iron core hitting the top of the valve body and the orifice of the bottom, and the high pressure and large air stream rubbing the orifice. This article studies the method to reduce mechanical noise of the electromagnetic valve core, that is to reduce the above movement energy and the hitting force. The method is used in ECP devices with grafying results. This noise controlling technology may reduce the noise of the electromagnetic valve from higher than 50dB to less than 25dB.

Counterpulsation↗
PubMed2006

[Effects of external counterpulsation on shear stress and production of nitric oxide and cGMP in canines with myocardial infarction].

OBJECTIVE: To investigate the effects of external counterpulsation (ECP) on shear stress and signal transduction in canines with myocardial infarction. METHODS: Nineteen healthy dogs were randomly divided into control, ischemia, and ischemia plus ECP groups. Myocardial infarction was induced in the latter two groups by ligation of the left anterior descending artery (LAD). Serum and aorta NO levels of the dogs were determined by modified nitrate reductase method, and serum and aorta cyclic guanosine monophosphate (cGMP) levels by radioimmunoassay. RESULTS: The shear stress in the truncus brachiocephalicus decreased after LAD ligation, but increased significantly after 2 h of ECP treatment. Serum and aorta NO levels in ECP and control groups were significantly higher than those in the ischemic group (P<0.05). Serum and aorta cGMP levels in control group and ECP group after LAD ligation were also significantly higher than those in the ischemic group (P<0.05). CONCLUSION: ECP can increase the shear stress and increase NO and cGMP levels in dogs with myocardial ischemia, which might be an important mechanism of ECP for protection of the ischemic myocardium.

Animals↗
PubMed1992

Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation.

OBJECTIVE: --To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest. DESIGN AND SETTING: --Randomized controlled trial in a university-affiliated hospital. PATIENTS: --Patients experiencing in-hospital cardiac arrest during a 6-month period. INTERVENTIONS: --Patients were randomized to receive either IAC during CPR or standard CPR in the event of cardiac arrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min. MAIN OUTCOME MEASURES: --The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge. RESULTS: --During the study period there were 135 resuscitation attempts in 103 patients. Return of spontaneous circulation was significantly greater in the group receiving IAC during CPR than in the group receiving standard CPR (51% vs 27%, P = .007). At hospital discharge, a significantly greater proportion of patients was alive in the IAC group than in the control group (25% vs 7%, P = .02). Eight (17%) of 48 patients who received IAC during CPR survived to hospital discharge neurologically intact, compared with only three (6%) of 55 patients from the standard CPR group (not significant). CONCLUSIONS: --We conclude that the addition of IAC to standard CPR may improve meaningful survival following in-hospital cardiac arrest. The optimal use of this technique awaits further clinical trials.

Adult↗
PubMed1991

[External counterpulsation in treating angina pectoris evaluated by Tl-201 myocardial perfusion imaging].

Twenty patients with angina pectoris were treated with external counterpulsation (ECP) for 36 hours, and the effects of the therapy were evaluated by comparing the images of thallium-201 myocardial perfusion before and after ECP. Improvement of myocardial perfusion after ECP, evidenced by decrease in area of defects in scintigram, was demonstrated in 15 (75%) cases. The mechanism of the effect of ECP on ischemic myocardium was discussed.

Adult↗
PubMed1990

[Circulatory assist device in counterpulsation].

PURPOSE: To test a circulatory assist device (CAD) developed in the University of São Paulo. Heart Institute, Bioengineering Division. It is a valveless chamber working through the counterpulsation principle, aiming at assistance to temporary the left ventricle. PATIENTS AND METHODS: The CAD consists of a rigid polycarbonate shell, which houses in its interior a polyurethane bag with a maximum volume of 110 cm3, driven alternately by pressure and vacuum from an external electropneumatic device synchronized with the ECG. The device worked for 300 hours in a test bench simulating the cardiovascular system in order to verify its resistance to wear and fatigue. The CAD was implanted near the aortic root of five dogs, in whom cardiac failure was induced through the use of propranolol and plasma expanders. The CAD was driven for five periods of 2 minutes separated by pauses of equal duration. The hemodynamic parameters were measured during the mentioned periods. RESULTS: "In vitro" testing resulted in no wear or fatigue. No leakage was observed. In the "in vivo" testing the averages obtained during the on and off periods of the device showed for the on periods; a) lowering of the systolic pressures of both the aorta (17.5%) and the left ventricle (LV) 15.1%), lowering of the final diastolic pressure of the LV (15.4%) and lowering of the diastolic pressure of the aorta (27.4%); b) increase in cardiac output (45.5%); c) increase of the endocardial viability ratio by 37.5%. CONCLUSION: The tested device represents a therapeutic option in cases of acute left ventricle failure, since with it an improved cardiac performance was measured and an increased coronary perfusion can be presumed.

Animals↗
PubMedDate not supplied

Efficacy of a biomechanical counterpulsation device powered by skeletal muscle for right heart assist.

A valveless, single-orifice counterpulsation device powered by skeletal muscle was applied to the pulmonary artery for right heart assist. Latissimus dorsi muscles of six dogs had been electrically conditioned for four months in advance (Group 1); the muscles of eight dogs were not preconditioned (Group 2). A polyvinyl chloride balloon was placed beneath the latissimus dorsi muscle and connected to the left pulmonary artery using a noncollapsing graft. Latissimus dorsi muscle was paced synchronously to the cardiac cycle to produce pulmonary artery diastolic augmentation. Percent changes in diastolic augmentation pressure (% DAP) in the main PA was measured. Percent DAP after 180 min assistance was 91 +/- 10% in Group 1, whereas it decreased to 17 +/- 12% in Group 2 (p less than 0.001). These results demonstrate that electrically conditioned skeletal muscle is effective as a power source in right heart assist.

Animals↗
PubMed1990

[Doppler echocardiography evaluation of left ventricular function in intra-aortic balloon counterpulsation].

Doppler-echocardiographic measurement of transaortic and mitral flow allows an assessment of systolic and diastolic left ventricular performance. To evaluate the hemodynamic effects of intra-aortic balloon counterpulsation (IABP) 10 patients were examined during IABP after myocardial infarction or cardiothoracic surgery. Doppler echocardiographic transaortic (VAo), early (VE) and late (VA) transmitral flow velocities, transaortic velocity time integral (VTIAo), acceleration and deceleration intervals and rates were obtained. The IABP augmentation was changed from 1:1, 1:2 to 1:4 causing no notable change in invasively measured arterial pressures (p greater than 0.05). With constant heart rate the VE/VA ratio was similar in 1:2 and 1:1 mode (1.44 +/- 0.42 vs 1.47 +/- 0.27; p greater than 0.2), whereas VAo and VTIAo were increased (p less than 0.01). A beat-to-beat analysis during 1:2 mode confirmed an increase in VAo (84.1 +/- 13.5 vs 98.3 +/- 16.5 cm/s; p less than 0.01) and VTIAo after the augmenting balloon inflation, but did not confirm any concomitant effect on diastolic transmitral parameters; acceleration and deceleration intervals were not changed. Thus, Doppler-echocardiography was able to detect an increase in transaortic flow during IABP augmentation by beat-to-beat analysis. The increase in VTIAo indicates an elevated cardiac output. A similar instantaneous effect on the diastolic transmitral flow could not be identified.

Blood Flow Velocity↗
PubMed1990

[Arterial injuries caused by the insertion of an intra-aortic counterpulsion balloon].

Insertion of an intra-aortic counterpulsion balloon was necessary following 283 surgical procedures with the heart pump at Hospital Broussais. One instance of vascular trauma at the site of insertion of the balloon was reported in 36 cases (13 p. cent). This was treated according to the severity of the arterial lesion with the following techniques: closure with Goretex venous patch (n = 25), short ilio-femoral by-pass (n = 9) and extra-anatomical femoro-femoral by-pass (n = 2). The overall mortality of the patients who required an intra-aortic balloon was 19 p. cent, including one case of retrograde aortic dissection at the site of insertion of the balloon. The morbidity related to the insertion of the balloon was as follows: one leg amputation, two disabling intermittent claudication episodes.

Arteriosclerosis↗
PubMed1989

Nursing implication for pulmonary artery balloon counterpulsation: a treatment for right ventricular dysfunction after cardiac surgery.

PPRVD is a phenomenon frequently observed in the operating room. Its development can be attributed to a single or many factors associated with cardiac operation. Namely, its presence is precipated by injury to the RV myocardium or changes in the normal hemodynamic functions of the RV. While PPRVD occurs in isolation, it is usually seen with concomitant LV dysfunction. When conventional medical management of LV dysfunction does not improve yet unmasks RV dysfunction, some type of ventricular assist device to support RV dysfunction may be needed to wean patients from cardiopulmonary bypass such as PABC. PABC has been demonstrated to be useful in the management of mild to moderate PPRVD and weaning from CPB. Severe PPRVD has not been demonstrated to benefit from PABC. The major concern in managing PPRVD is the lack of quantifiable criteria for determining levels of RV injury. Research is continuing in this area. Likewise, investigations are under way to develop a transvenous PABC catheter. This catheter would allow for increased PABC use as it would not require surgical placement or removal. The present PABC model could potentially be used in any hospital that uses conventional intra-aortic balloon counterpulsation. The patient presented in this case was cared for in a 350-bed community hospital in the Northeast section of the United States. A PABC patient can present a unique nursing challenge. It is hoped that this article will assist nurses in the future management of these patients.

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PubMed1995

[Experimental study on organ perfusion by intraaortic balloon counterpulsation with double balloon catheter].

Newly-developed catheter for the intraaortic balloon counterpulsation with cardio-renal assist was examined on animal model. The catheter consists of two balloon segments between which the celiac trunk, the superior mesenteric artery and the renal artery are to be placed. Statistical comparison on each hemodynamic element was carried out between the catheter (DBC), conventional single balloon catheter (SBC) of the same balloon volume as DBC and no assist (None) groups. There were no significant changes between SBC and DBC in cardiac output, femoral arterial flow and central venous pressure. Renal arterial flow and urinary output were significantly increased in DBC (None 14.4 +/- 3.9, SBC 22.6 +/- 5.6, DBC 31.0 +/- 6.9 ml/min in renal arterial flow, None 33 +/- 9, SBC 64 +/- 14, DBC 78 +/- 20 ml/h in urinary output, p < or = 0.05). After the remodeling adjust to the human stature, a clinical application would be considered.

Animals↗
PubMed1993

[Immediate and long-term complications of counterpulsation balloon. Recent data apropos of a series of 200 consecutive patients].

The value of intra-aortic balloon counterpulsation as a means of circulatory assistance and of myocardial protection has been widely established, however percutaneous insertion has been associated with a high incidence of complications, reaching 50% in some series. The authors evaluated the immediate and secondary complications of percutaneous insertion under fluoroscopic control of 209 catheters (8.5F to 10.5F) in 200 consecutive patients. The average age was 64 +/- 11 years and 32% were female. The indications of the procedure were: cardiogenic shock (32.5%), high risk coronary angioplasty (19.2%), complications of coronary angioplasty (18.1%), prophylactic insertion before aorto-coronary bypass surgery (13.8%), unstable angina (2%), terminal cardiomyopathy (5.7%), shock (6.7%), others (2%). There were major complications in 10 cases (4.8%): acute lower limb ischaemia requiring surgery (8 cases), bleeding from the femoral artery requiring surgical repair (1 case) and septicaemia (1 case). Minor complications were observed in 19 cases (9%): haematoma (6 cases), lower limb ischaemia reversible with removal of the catheter (10 cases) or with medical treatment (2 cases), superficial infection (1 case). With a mean follow-up of 17 months for 97% of patients, only one false aneurysm of the femoral artery requiring surgery and one case of intermittent claudication were observed. These results suggest that, in operators trained in femoral artery catheterization, the percutaneous insertion of an intra-aortic balloon under fluoroscopic control is justified by the simplicity of the procedure and low rate of complications.

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