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PubMed1988

Preclinical evaluation of the abdominal aortic counterpulsation device.

A valveless, single-orifice abdominal aortic counterpulsation device (AACD) was implanted retroperitoneally on the abdominal aorta and was pumped continuously, providing aortic diastolic augmentation for 45 +/- 4.9 days in four calves (group A). The hematocrit, lactate dehydrogenase (LDH), bilirubin, blood urea nitrogen, and creatinine were obtained before implantation and weekly thereafter. Biocompatibility data were compared to those obtained from 11 calves (group B) that received a total artificial heart (TAH) and were electively terminated 50.0 +/- 19.5 days after implantation. The hematocrit values in the first week were 20.9 +/- 11.5% and 39.8 +/- 11.5% below control values for group A and group B, respectively (p less than 0.02); in the sixth week they were 5.1 +/- 14.6% above control values (group A) and 22.6 +/- 9.0% below control values (group B) (p less than 0.05). LDH did not change in group A, while in group B it was constantly about 100% above control values. Autopsy revealed one to three infarcts 1 to 3 mm in diameter in 63% of the kidneys in group A, while in all of group B kidneys there were multiple infarcts of more than 10 mm. After the induction of left ventricular (LV) failure, the AACD decreased the LV end-diastolic pressure (EDP) by 21.2% (p less than 0.005) and the aortic (AO) EDP by 18% (p less than 0.005). It increased the endocardial viability ratio by 300% (p less than 0.0005), and the cardiac index by 66.9% (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1979

Medically refractory unstable angina pectoris. I. Long-term follow-up of patients undergoing intraaortic balloon counterpulsation and operation.

Of 82 patients with medically refractory unstable angina pectoris seen between October 1972 and January 1978, 60 patients underwent a combination of intraaortic balloon pump counterpulsation, cardiac catheterization and coronary revascularization. Most patients had atherosclerotic involvement of the vessels of the anterior left ventricular wall, 48 patients (80 percent) had abnormalities of left ventricular wall contraction and 22 patients (36 percent) had evidence of acute myocardial injury. One operative and one late death occurred. The perioperative infarction rate was 5 percent. Survivors, followed up for 3 to 63 months (mean 31 months), have done remarkably well; 77 percent are considered employable,and more than 90 percent are in functional class I or II.

Angina Pectoris↗
PubMed1997

Economic implications of the prophylactic use of intraaortic balloon counterpulsation in the setting of acute myocardial infarction. The Randomized IABP Study Group. Intraaortic Balloon Pump.

Intraaortic balloon counterpulsation (IABP) has been shown to improve coronary artery patency and reduce the rates of recurrent myocardial ischemia and its sequelae in selected patients when used within 24 hours of acute myocardial infarction. The economic implications of prophylactic IABP use are unknown. We obtained hospital bills for 102 patients enrolled in the Randomized IABP Trial (56%) and converted charges to costs using each hospital's Medicare cost report. In-hospital costs for patients who had 48 hours of IABP were compared with those of patients who did not. The costs of angiographic and clinical complications were determined. Small differences in clinical and angiographic characteristics existed between patients in the economic substudy and the overall population, but overall angiographic and clinical outcomes were comparable. Costs for patients who had IABP versus control patients were similar: mean $22,357 +/- $14,369 versus $19,211 +/- $8,414, median (25th and 75th percentiles) $17,903 ($15,787, $22,147) versus $17,913 ($15,144, $21,433), p = 0.45. Hospital costs were higher with the development of recurrent ischemia: mean $23,125 +/- $7,690 versus $20,416 +/- $12,449, median $21,069 ($17,896, $26,885) versus $17,492 ($14,892, $20,998) p = 0.02. Patients who had an adverse clinical event (death, stroke, reinfarction, and emergency revascularization) also had higher hospital costs: mean $25,598 +/- $10,024 versus $19,790 +/- $12,045, median $21,877 ($18,380, $28,049) versus $17,364 ($14,773, $20,779), p = 0.002. The prophylactic use of IABP in patients at high risk of infarct artery reocclusion within 24 hours of acute myocardial infarction provides sustained clinical benefit without substantially increasing hospital costs.

Aged↗
PubMed1985

Abdominal counterpulsation in cardiopulmonary resuscitation: animal models and theoretical considerations.

Abdominal counterpulsation improves blood flow during otherwise standard CPR in animal models and in electronic models of the circulation. The method generates both central aortic and central venous pressure pulses. Success depends upon maximizing the former and minimizing the latter. Solution of a simple, first-order, differential equation may provide insight into proper technique. The equation suggests that the central arteriovenous pressure difference is maximized when pressure is applied directly over the abdominal aorta and when fluid loading is avoided. Proper technique may be critical in generating the largest possible arteriovenous pressure difference.

Abdomen↗
PubMed1992

Complications from intra-aortic balloon counterpulsation: a review of 303 cardiac surgical patients.

From January 1980 to January 1990 all patients undergoing cardiac surgery at the Royal North Shore Hospital, Sydney, and requiring intra-aortic balloon counterpulsation (IABCP) were retrospectively reviewed. A total of 99 patients (32.6%) developed complications. Vascular/haemorrhagic complications occurred in 46 patients (15.2%); 79 patients (26%) required platelet transfusions. We have found that only a history of hypertension was predictive of an increased incidence of developing vascular complications. Surgical intervention was required in 17 patients (5.6%), or 47% of the patients who developed a vascular complication. The mortality among patients requiring IABCP was 36.6%. Intra-aortic balloon pump-related deaths occurred in 6 patients (2%). Use of the intra-aortic balloon pump can be a life-saving procedure, but it carries a significant morbidity and mortality rate. This makes it imperative to temper our indications to those patients who demonstrate a need for it.

Adult↗
PubMed1993

Intra-aortic balloon counterpulsation in Denmark 1988-1991. Early results and complications.

During the years 1988-1991 6319 patients underwent cardiac surgical procedures in Denmark. In 183 patients (2.9%) with left ventricular failure intra-aortic balloon counterpulsation (IABP) was used. Four percent of the IABP were placed preoperatively, 86% intraoperatively and 10% postoperatively. Severe complications occurred in 16 patients (8.7%) and were mainly vascular due to limb ischemia. The incidence of complications was independent of the duration of balloon pumping. Sixty percent of the patients were weaned from IABP. The 30-day mortality rate was 54%. During the observation period we found a gradual decrease in the use of IABP as well as a reduction in mortality.

Cardiac Surgical Procedures↗
PubMed2006

Intra-aortic balloon counterpulsation.

Intra-aortic balloon counterpulsation (IABP) is sometimes used in critically ill patients with cardiac disease. By increasing diastolic arterial pressure and decreasing systolic pressure, it reduces left ventricular afterload. IABP may be beneficial in subjects with cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, or advanced heart failure or those who undergo "high-risk" surgical or percutaneous revascularization, but the evidence to support its use in these patient groups is largely observational. Contraindications to IABP include severe peripheral vascular disease as well as aortic regurgitation, dissection, or aneurysm. The potential benefits of IABP must be weighed against its possible complications (bleeding, systemic thromboembolism, limb ischemia, and, rarely, death).

Animals↗
PubMed2004

Intra-aortic balloon counterpulsation: variations in use and complications.

OBJECTIVE: To study variations in use of intra-aortic balloon counterpulsation (IABC) and their impact on complications by comparing aspects of its use in a Regional Cardiothoracic Centre with an international database. METHODS AND RESULTS: Indications, technique and complication rate in 764 consecutive patients treated with IABC from January 1998 to November 2001 (Group I) at the Regional Cardiothoracic Centre were compared with 24,555 consecutive patients from the international ("Benchmark") database (Group II). Patients in Groups I and II were of similar mean age (65.5 vs. 65.6 years) and predominantly males (77.1% vs. 66.9%). IABC-related complications were significantly less in Group I vs. Group II (3.93% vs. 7.04%, p<0.001), probably due to the increased use of smaller French size balloons (8f in Group I: 73.3% vs. Group II: 28.8%, p<0.001) and significantly less use of femoral artery sheaths (Group I: 91.2% vs. Group II: 20.4%, p<0.001) as well as less concomitant use of potent anti-thrombotic therapy (4.2% vs. 21.7%). By comparison to the international database only a minority of our patients were transferred in specifically for insertion of IABC (Group I: 1.3% vs. Group II: 22.8%, p<0.001) suggesting under-recognition of the potential value of IABC in haemodynamically compromised patients. CONCLUSION: In comparison to an international database, complications were significantly less after IABC at the regional cardiothoracic centre. There were far fewer patients referred specifically for IABC use. Indications, choice of appropriate device, technique of deployment and concomitant use of anti-platelet therapy varies and perhaps needs to be standardised internationally. Regular audit of any such large database is vital to ensure dissemination of potentially important messages it contains.

Aged↗
PubMed1976

Dissection of the aorta complicating intra-aortic balloon counterpulsation.

A 61-year-old man with recent myocardial infarction complicated by a ventricular aneurysm and recurrent ventricular tachycardia underwent intra-aortic balloon counterpulsation prior to angiography and left ventricular aneurysmectomy. A dissecting aneurysm of the descending aorta adjacent to the position of the balloon catheter was found at autopsy. No intimal tear or cystic medial degeneration of the aorta was present to account for the dissection. The authors suggest that lateral and shearing forces generated by inflation of the balloon could result in dissection of the aorta.

Aortic Dissection↗
PubMed1977

The hemodynamic response to intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction.

Sixteen patients with cardiogenic shock complicating acute myocardial infarction underwent serial hemodynamic studies during intra-aortic balloon counterpulsation (IABC) at an assist frequency of 1:1. Significant increase was noted during the first 12 hours of IABC in the systemic artery peak diastolic pressure (assisted), cardiac index, stroke index, and stroke work index. During the second 12 hours further significant improvement was noted in the latter three parameters and, in addition, the systemic artery systolic pressure increased significantly. The pulmonary wedge pressure fell as did the total systemic resistance (TSR) during the first 24 hours of IABC. Patients found to be balloon independent after reduction in balloon assist frequency demonstrated significantly greater increase in systemic artery peak diastolic pressure during the first 12 hours of IABC than did those patients found to be balloon dependent. Likewise, the improvement noted in CI, SI, and SWI during the second 12 hours of IABC was of greater magnitude in balloon-independent than in balloon-dependent patients. The data suggest late hemodynamic deterioration after 48 hours of IABC. It is concluded that IABC is effective in improving the deranged hemodynamics of cardiogenic shock. Maximum response is noted between 24 and 48 hours. It is suggested that patients who are balloon independent may be distinguished from those who are balloon dependent by the hemodynamic response within the first 24 hours of IABC.

Acute Disease↗
PubMed1998

Effective arterial elastance and the hemodynamic effects of intraaortic balloon counterpulsation in patients with coronary heart disease.

OBJECTIVES: The goal of the present study was to analyze the effects of different intraaortic balloon counterpulsation (IABC) inflation volumes on effective arterial elastance (Ea) in patients with complicated coronary heart disease and to determine whether Ea can predict the hemodynamic response to IABC. BACKGROUND: Ea (the central aortic end-systolic pressure to stroke volume ratio) incorporates the principal elements of input arterial impedance and has been proved useful to evaluate the effects of afterload reduction in patients with left ventricular (LV) failure. However, although the hemodynamic action of IABC can be considered as a typical example of "pure" afterload reduction, it has never been assessed in terms of changes in Ea. METHODS: After clinical stabilization, 18 patients treated with IABC for complicated acute myocardial infarction or unstable angina were enrolled in the study. Systemic hemodynamics were measured by use of right cardiac thermodilution catheters with IABC off (control) and IABC on at balloon inflation volumes of 20 and 40 ml, in randomized sequence. Aortic pressure was recorded through the central lumen of the IABC catheter to calculate Ea as the ratio of aortic dicrotic pressure to stroke volume. RESULTS: A higher control Ea was associated with a lower control LV stroke work and a larger IABC-related hemodynamic improvement (that was maximal with the 40 ml inflation volume). The increase in LV stroke work was closely related to the decrease in Ea. Accordingly, hemodynamic benefits from IABC were less evident in patients with lower control Ea. In conclusion, effects of IABC were related to both balloon inflation volume and control hemodynamics, reflecting the afterload dependence of a depressed LV function.

Aged↗
PubMed1999

Intra-aortic balloon counterpulsation before primary percutaneous transluminal coronary angioplasty reduces catheterization laboratory events in high-risk patients with acute myocardial infarction.

The benefit of intra-aortic balloon counterpulsation (IABC) before primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction in high-risk patients has not been well documented. Consecutive patients (n = 1,490) with acute myocardial infarction treated with primary PTCA from 1984 to 1997 were prospectively enrolled in an ongoing registry. Catheterization laboratory events occurred during or after intervention in 88 patients (5.9%), including ventricular fibrillation in 59 patients (4.0%), cardiopulmonary arrest in 46 patients (3.1%), and prolonged hypotension in 33 patients (2.2%). Cardiogenic shock was the strongest predictor of catheterization laboratory events (odds ratio [OR] 2.18, 95% confidence intervals [CI] 1.58 to 3.02) followed by low ejection fraction (<30%) (OR 1.51, 95% CI 1.06 to 2.15) and congestive heart failure (CHF) (OR 1.45, 95% CI 1.01 to 2.07). IABC used before intervention was associated with fewer catheterization laboratory events in patients with cardiogenic shock (n = 1 19) (14.5% vs. 35.1%, p = 0.009), in patients with CHF or low ejection fraction (n = 119) (0% vs. 14.6%, p = 0.10), and in all high-risk patients combined (n = 238) (1 1.5% vs. 21.9%, p = 0.05). IABC was a significant independent predictor of freedom from catheterization laboratory events (OR 0.48, 95% CI 0.29 to 0.79). These data support the use of IABC before primary PTCA for acute myocardial infarction in all patients with cardiogenic shock, and suggest that prophylactic IABC may also be beneficial in patients with CHF or depressed left ventricular function.

Aged↗
PubMed2001

Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass operations.

BACKGROUND: Dislocations of the heart required for exposure and construction of distal anastomoses often produce hemodynamic instability when performing coronary artery revascularization without using cardiopulmonary perfusion (OPCAB). We report our early experience with elective intraaortic balloon counterpulsation (IABP) to enable and facilitate selected high-risk patients to undergo OPCAB. METHODS: Sixteen high-risk patients undergoing multivessel OPCAB using elective IABP are reported. The patients were believed to be at increased risk because of the presence of severe proximal multivessel coronary artery obstruction, ventricular dysfunction, recent acute myocardial infarction, cardiomegaly-cardiomyopathy, and documented cerebral vascular disease. The presence of significant comorbid disease also made the avoidance of cardiopulmonary bypass desirable, if at all possible, in all patients. RESULTS: The IABP appeared to facilitate the intraoperative management of our series of patients. This was evidenced by improved hemodynamic stability and virtual elimination of the need for inotropic support during the dislocations of the heart needed for exposure and construction of distal anastomoses. There were no complications related to use of IABP. There was one death. CONCLUSIONS: We believe this strategy to use IABP selectively can allow surgeons to safely extend the benefits of OPCAB procedures to high-risk patients and avoid dangerous hemodynamic instability that otherwise, often occurs.

Aged↗
PubMed1987

A valveless counterpulsation left ventricular assist pump in the descending aorta: hemodynamic benefit with a reduced risk of cerebral emboli.

Because of valve malfunction and cerebral embolism reported with use of the total artificial heart, the descending aorta was reexamined as a site for a valveless counterpulsation left ventricular assist pump. The pump was introduced into the thoracic aorta at the level of the eight thoracic vertebra in 11 canine right-heart bypass preparations. Heart rate (110 beats per minute), stroke volume (20 ml), and mean arterial pressure (80 or 100 mm Hg) were precisely controlled. The pump ejection volume was adjusted to equal 1 time or 2 times the stroke volume of the dog. A 20-ml ejection led to an 11% reduction in left atrial pressure, an 11% reduction in peak left ventricular pressure, and a 20% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). Systolic shortening (ultrasonic crystals) increased by 5% (p less than .05 at a mean arterial pressure of 80 mm Hg). A 40-ml pump ejection led to an 11% reduction in mean left atrial pressure, a 17% reduction in peak left ventricular pressure, and a 21% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). The systolic shortening increased by 15% (p less than .05). To assess the relative risk of cerebral embolism, albumin spheres (40 to 60 micrograms) labeled with technetium-99 were injected into the pump chamber in 5 dogs (40-ml ejection, 2.1 +/- 0.1 times the dog's stroke volume).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1977

Results and complications of intraaortic balloon counterpulsation.

During the forty-month period ending July, 1976, intraaortic balloon counterpulsation was used as an adjunct to medical or surgical therapy in 273 patients. Thirty-seven developed complications. Limb ischemia occurred in 16; it resolved in 12, resulted in gangrene of the toes in 1 and leg gangrene in 2, and was the casue of death in 1 patient. Aortic dissection was confirmed in 7 patients and strongly suspected in another 4. Eight of the 11 patients with dissection underwent cardiac procedures with heparinization at two days to three months after balloon insertion with no untoward effects. Septicemia developed in 2 patients, 1 of whom died of cardiogenic shock. Localized groin sepsis occurred in 8 patients, 2 of whom required removal of infected Dacron graft material. Awareness of the complications of balloon insertion, proper attention to details of balloon management at the time of insertion and removal, and continuous monitoring through a central-lumen balloon should decrease the incidence of complications.

Adolescent↗
PubMed1977

Intraoperative application of intraaortic balloon counterpulsation determined by clinical monitoring of the endocardial viability ratio.

Persistent unrecognized subendocardial ischemia with development of subendocardial necrosis is a major cause of patient death following cardiopulmonary bypass. The lesion is caused by a discrepancy between the oxygen needs of subendocardial muscle and the available blood supply. If sole reliance is placed upon monitoring conventional vital signs, the more subtle factors contributing to decreased blood flow may go unrecognized. Reported studies have confirmed that the adequacy of subendocardial perfusion can be predicted by calculating the supply/demand ratio, defined as the ratio of the diastolic pressure-time index (DPTI) divided by the systolic pressure-time index (TTI). An analog computer was designed and built that measures the area under the systolic and diastolic component, calculates the DPTI/TTI ratio, and digitally displays the result as the endocardial viability ratio (evr). The EVR was used to determine the adequacy of left ventricular subendocardial blood flow in 64 consecutive patients undergoing cardiac operations. Unidirectional intraaortic balloon counterpulsation (IABC) was utilized in 14 patients with 9 long-term survivors. The difference in mean EVR between survivors and nonsurvivors at the initiation of balloon support was statistically significant. Early application of unidirectional IABC when subendocardial ischemia persists following open cardiac procedures may prevent deterioration to subendocardial necrosis with subsequent morbidity or mortality.

Assisted Circulation↗