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PubMed1975

[Diagnostic and therapy of postoperative cardiac low-output-syndrome by means of intraaortic balloon pumping (IABP) or external counterpulsation (ECP)--a comparison (author's transl)].

A beneficial influence on the myocardial energy imbalance of the hypoxaemically damaged heart can be reached with either intraaortic balloon pumping (IABP) or external counterpulsation (ECP). In the realm of our acquired clinical experience with two groups of patients, the technical demands of these cardiac assist devices are discussed and distinguished from one another in relation to different indications.

Adult↗
PubMed1976

[Treatment of cardiogenic shock after acute myocardial infarction with intra-aortic balloon counterpulsation (author's transl)].

Intra-aortic balloon counterpulsation (IABP) was used in 20 patients with acute myocardial infarction and cardiogenic shock, after four hours of drug treatment. In all instances the abnormal haemodynamic state had been demonstrated. Four patients were successfully treated and finally discharged home. In two with post-infarction ventricular septal defect and cardiogenic shock, IABP also successfully reversed the shock state, while in seven the shock state was reversed but they died 2-8 days after IABP had been stopped. IABP failed in seven patients who died during its application. In those in whom IABP failed there had been no significant fall in pulmonary-artery pressure and no significant increase in stroke volume. The post-mortem examinations demonstrated that cardiogenic shock was irreversible where more than 50% of the left ventricular myocardium had been infarcted.

Acute Disease↗
PubMed1975

[Clinical and haemodynamic results with intra-aortic counterpulsation (author's transl)].

The AVCO balloon pump (model 7) was used on 13 patients with cardiogenic shock and for circulatory support after open-heart surgery. Twelve patients survived, but one patient died of a cerebral embolism which had occurred before the use of the balloon pump. Mean systemic arterial pressure, mean pulmonary artery pressure, pulmonary wedge pressure and heart rate were measured in all patients, while cardiac index and arterio-venous oxygen difference were measured in seven. Average duration of counterpulsation was four days. Vasopressor treatment was reduced or discontinued in all patients, urinary output increased markedly and the clinical state improved. Although systolic pressure did not change significantly, MAP increased significantly by 25 mm Hg (P less than 0.005), with a mean diastolic pressure increase to 104 mm Hg. The pulmonary artery pressure, the pulmonary wedge pressure and the mean pulse rate all decreased significantly by 25 mm Hg, 16 mm Hg and 24 beats/min, respectively. A fall in arterio-venous oxygen difference of 2.6 ml/100 ml (P less than 0.025) was associated with a significant increase in cardiac index by 0.62 l/min-m2 (P less than 0.025). It is concluded from these results that intra-aortic balloon counter-pulsation may be an effective means of providing circulatory support in cardiogenic shock and after open-heart surgery.

Arteries↗
PubMed1997

Vascular complications related to intraaortic balloon counterpulsation: an analysis of ten years experience.

We have performed a retrospective review of our experience with the intraaortic balloon counterpulsation pump (IABP) during the last decade, to identify aspects of risk factors, complications, and management that affect peripheral vascular morbidity and mortality. Data from 472 patients who had the IABP inserted during the ten-year period from December 1985 to December 1995 were retrospectively reviewed. Risk factors, implantation techniques, complications, and significant variables were evaluated. One hundred forty-five vascular complications needed surgical therapy in 116 patients. Mean age was 62.2 +/- 12.9 years. There were 84 (72.5%) men and 32 (27.5%) women. Mortality rate was 28.3% (n = 181). The mortality for patients with ischemic vascular complications was significantly higher than in patients who did not suffer any vascular complication (59.6% vs 30.1%, p = 0.0001). Complications included acute limb arterial occlusion in 99 cases (68.3%), compartment syndrome in 27 (18.6%), groin hematoma in 15 (10.3%), and persistent lymph fistula in 4 (2.8%). Of these, 97 (76.9%) occurred during IABP therapy and 29 (23.1%) after IABP explantation. Thromboembolectomy was required for 61 (42.2%) of the ischemic limbs. Associated procedures were 24 (16.5%) profundaplasties, 10 (7%) infrainguinal bypasses (5 (3.4%) femoropopliteal supragenicular, 3 (2.2%) femoropopliteal infragenicular, and 2 (1.4%) infrapopliteal), 26 (17.9%) fasciotomies, and 5 (3.4%) amputations. A history of peripheral vascular disease (31 patients [43.6%] with vs 95 [23.6%] without, p < 0.05) and the presence of diabetes mellitus (70 patients [49.2%] with vs 56 [16.9%] without) increased the risk of limb ischemia significantly. Female sex, insertion of IABP by percutaneous technique, and direct removal with groin compression were associated with higher ischemic complication rates, the differences however were not significant. Itis concluded that 1. Limb ischemia remains the primary complication after IABP insertion; 2. Femoral artery thromboembolectomy is usually sufficient for revascularisation; 3. Adequate implantation and surgical explantation techniques are essential to reduce the IABP-related morbidity; 4. Identification of subclinical disease may aid in the management of subsequent acute limb ischemia; 5. The presence of peripheral vascular disease and diabetes mellitus are associated with higher ischemic complication rates.

Aged↗
PubMed1995

[Intra-aortic balloon counterpulsation as percutaneous therapy option in cardiogenic shock].

Six months after sustaining a posterior wall myocardial infarction a 40-year-old man had a further infarction in the anterior wall region. After thrombolysis treatment with recombinant tissue plasminogen activator the patient was at first symptom-free and haemodynamically stable, but 48 hours later another anterior wall re-infarction occurred with cardiogenic shock. Despite infusions of catecholamines at highest dosage and successful coronary angioplasty the circulation became critically unstable and percutaneously introduced intraaortic balloon counterpulsation (IABCP) was commenced. As the haemodynamics improved catecholamine dosage was markedly reduced and then discontinued over the subsequent 24-48 hours and inspiratory oxygen concentration of the ventilated patient was decreased from 100% to 40%. After a total of 5 days the IABCP catheter was removed without complication. The cardiac pump action showed further improvement in the following days. 6 months later the patient's condition was stable in grade II-III (New York Heart Association classification) heart failure. This case illustrates the place of IABPC as a highly effective treatment option in myocardial infarction with cardiogenic shock, especially when combined with interventional revascularisation procedures.

Adult↗
PubMed2000

Sex and other predictors of intra-aortic balloon counterpulsation-related complications: prospective study of 1119 consecutive patients.

BACKGROUND AND OBJECTIVE: Intra-aortic balloon counterpulsation (IABC) complication rates remain significant despite technical advances that have simplified and expanded its use. Previous reports implicated patient height, diabetes, or peripheral vascular disease as risk factors. However, these studies were small and not prospective. Therefore a prospective study at one high-volume center was conducted examining the complications associated with IABC and the role of sex and other risk factors in the current era. METHODS: The study prospectively evaluated 1174 consecutive percutaneous IAB insertions in 1119 patients between 1993 and 1997. Major complications were defined as embolism or limb ischemia requiring surgery; bleeding requiring transfusion or surgery; systemic infection; balloon rupture; or death from one of these causes. Minor complications were defined as limb ischemia or pulse loss resolving without surgery or after IAB removal or bleeding not requiring transfusion or surgical intervention. All variables were analyzed with univariate and stepwise multivariate analysis. RESULTS: Data were collected on 1119 patients (727 men and 392 women) with a mean age of 65 +/- 11 years. The prevalence of diabetes, hypertension, and peripheral vascular disease was 27%, 52%, and 8%, respectively. Complications occurred in 166 patients (15%) and a major complication occurred in 126 (11%) of the 1119 patients. Multivariate logistic regression analysis was done with demographic, clinical, and procedural variables in a cohort of 1106 patients. The analysis identified peripheral vascular disease (relative risk [RR] 4.1), female sex (RR 2.3), and body surface area (RR 0.26 per m(2)) as independent predictors of a major complication. In addition, cardiac index (RR 0.7) was also identified as an independent predictor of any or major complications in a subset of 915 patients. In 754 high-risk patients (women or patients with peripheral vascular disease, diabetes, cardiac index <2.2 L/min/m(2), or body surface area <1.8 m(2)), 114 major complications occurred (15%) compared with 8 (3%) among 278 non-high-risk patients (P <.0001). CONCLUSIONS: The current complication rate associated with IABC remains significant. Advances in IAB technology need to focus on the high-risk subset of patients that includes women, smaller patients, and those with peripheral vascular disease.

Aged↗
PubMed2001

The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2.

BACKGROUND: Cardiogenic shock complicating acute myocardial infarction (AMI) remains the leading cause of death in patients hospitalized with AMI. Although several studies have demonstrated the importance of establishing and maintaining a patent infarct-related artery, it remains unclear as to whether intra-aortic balloon counterpulsation (IABP) provides incremental benefit to reperfusion therapy. The purpose of this study was to determine whether IABP use is associated with lower in-hospital mortality rates in patients with AMI complicated by cardiogenic shock in a large AMI registry. METHODS: We evaluated patients participating in the National Registry of Myocardial Infarction 2 who had cardiogenic shock at initial examination or in whom cardiogenic shock developed during hospitalization (n = 23,180). RESULTS: The mean age of patients in the study was 72 years, 54% were men, and the majority were white. The overall mortality rate in all patients who had cardiogenic shock or in whom cardiogenic shock developed was 70%. IABP was used in 7268 (31%) patients. IABP use was associated with a significant reduction in mortality rates in patients who received thrombolytic therapy (67% vs 49%) but was not associated with any benefit in patients treated with primary angioplasty (45% vs 47%). In a multivariate model, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18% (odds ratio, 0.82; 95% confidence interval, 0.72 to 0.93). CONCLUSIONS: Patients with AMI complicated by cardiogenic shock may have substantial benefit from IABP when used in combination with thrombolytic therapy.

Aged↗
PubMed1989

Intra-aortic balloon counterpulsation: a treatment for ischaemic stroke?

Intra-aortic balloon counterpulsation (IABC) augments cardiac output (CO) and pulse pressure (PP) allowing patients with low output heart failure to be supported for a period of time. Augmentation of CO and PP may also be beneficial to the patient with acute cerebral ischaemia. In this paper we investigated the possibility of using IABC to increase local cerebral blood flow (CBF) in ischaemic brain. In 12 anaesthetized mongrel dogs, a canine stroke model was produced by occluding the left internal carotid and middle cerebral arteries with aneurysm clips. Six dogs were then treated with IABC for 2 h, and 6 other dogs acted as controls (no IABC). Haemodynamic data were measured continuously and CBF (microsphere technique) and CO measurements were performed pre- and post-occlusion, and then twice during the treatment period. In the IABC-treated animals, PP increased from 32 +/- 5.9 to 39 +/- 7.8 mmHg (p less than 0.01) but CO and local CBF in the ischaemic brain did not change significantly during IABC. However, in 4 dogs with significant increases in CO due to IABC [1.7 +/- 0.3 to 2.8 +/- 0.7 l/min (p less than 0.05)], local CBF in ischaemic brain also increased significantly from 22 +/- 12 to 26 +/- 11 cc/100 g/min (p less than 0.05). In the control animals, CO and local CBF did not change significantly during the observation period. These data suggest that augmentation of CO and PP by IABC results in an increase in local CBF in ischaemic brain. IABC may be an effective treatment for ischaemic stroke in those patients with compromised cardiac performance whose cardiac output and pulse pressure can be augmented by IABC.

Animals↗
PubMed1993

Intra-aortic balloon counterpulsation improves survival in cardiogenic shock complicating acute myocardial infarction.

The impact of intra-aortic balloon counterpulsation (IABC) on survival of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) has been evaluated in this study of 85 patients. IABC was available for the 24 group A patients (and used in 20 patients). IABC was not available for the 21 group B patients who presented simultaneously with similar clinical characteristics and received identical pharmacological treatment. In-hospital and one year survival was significantly higher in group A (46% and 38% vs 19% and 10%, P < 0.001). Sixteen out of the 20 (group A1) IABC patients received early coronary revascularization. During 1980-1984, 35 patients with AMI and CS received IABC (group C) but none underwent early revascularization. There was no difference in in-hospital or one-year survival between group A1 (50% and 40%) and group C (45% and 40%). We conclude that early IABC improves survival of patients with AMI complicated by CS.

Combined Modality Therapy↗
PubMed1987

Long-term survival after counterpulsation for medically refractory heart failure complicating myocardial infarction and cardiac surgery.

Intra-aortic balloon counterpulsation (IABP) was performed in 225 patients over a 12-year period for the treatment of severe left ventricular failure following acute myocardial infarction and cardiac surgery, and which had failed to respond to conventional therapy. Of these patients, 97 (43%) were discharged alive from hospital. Patients were followed-up for a mean of 5.8 years (3 months to 11 years) and assessment of functional status was made. In patients with shock after myocardial infarction, the most favourable outcome was seen in patients who had mechanical cardiac defects which were corrected after institution of IABP and in those treated within 8 hours of the onset of shock; of those patients without shock, best results were seen in patients who had evidence of continuing ischaemia prior to IABP. In patients treated after cardiac surgery, long-term results were favourable in patients with good pre-operative left ventricular function and in those who underwent coronary artery bypass grafting or aortic valve replacement. Long-term results in patients treated with IABP for refractory cardiac failure are encouraging and suggest that IABP should have a continuing role in certain high risk patient groups.

Adult↗
PubMed1976

Mechanical circulatory assistance with intra-aortic balloon counterpulsation for major abdominal surgery.

Intra-aortic balloon counterpulsation (IABC) provides effective mechanical circulatory assistance (MCA) in many patients with cardiac disease characterized by low cardiac output and/or myocardial ischemia. The intra-aortic balloon pump (IABP) has been used almost exclusively in the care of patients with cardiac disease as their primary medical disorder. This report presents use of the IABP in three cases where cardiac disease was present, but abdominal pathology necessitating urgent surgical intervention was the primary medical concern. Experience with these three cases suggest that operative and early postoperative use of IABC in patients with documented heart disease undergoing major non-cardiac surgical procedures may reduce the high incidence of cardiac complications.

Abdomen↗
PubMed1983

Intra-aortic balloon counterpulsation in blunt cardiac injury.

Intra-aortic balloon counterpulsation (IABC) is a widely used form of mechanical circulatory assistance. We have successfully employed IABC in three patients with refractory cardiogenic shock secondary to cardiac contusion. All patients had multiple blunt injuries with cardiac contusion documented electrocardiographically, by CPK isoenzyme determinations, and clinically. IABC was instituted for hypotension refractory to vasoactive drugs and optimization of intravascular volume status. Cardiac output and blood pressure rose in all cases and fewer ventricular arrhythmias were noted. Discontinuation of IABC was possible within 48 hours in all cases with adequate cardiac performance. We conclude that IABC is a useful approach in the treatment of refractory cardiogenic shock associated with cardiac contusion.

Accidents↗
PubMed1998

Intra-aortic balloon counterpulsation augments cerebral blood flow in the patient with cerebral vasospasm: a xenon-enhanced computed tomography study.

OBJECTIVE: We previously established the ability of intra-aortic balloon counterpulsation (IABC) to improve cerebral blood flow (CBF) significantly in a canine model of cerebral vasospasm. This study was performed to assess the efficacy of IABC in a patient with cardiac dysfunction and severe cerebral vasospasm that was refractory to traditional treatment measures. METHODS: We report our experience with the clinical use of IABC to treat cerebral vasospasm in a patient who suffered subarachnoid hemorrhage and concomitant myocardial infarction. Hypertensive, hypervolemic, hemodilution therapy was ineffective, and IABC was instituted. Xenon-enhanced computed tomography (Xe-CT) was utilized to obtain serial measurements of CBF with and without IABC over a 4-day period. RESULTS: IABC dramatically improved cardiac function in this patient, and Xe-CT demonstrated significant improvement in CBF with IABC. The average global CBF was 20.5 +/- 4.4 ml/100g/min before versus 34.7 +/- 3.8 ml/100g/min after IABC (p < 0.0001, paired student's t-test). The lower the CBF before IABC, the greater the improvement with IABC (correlation coefficient r = 0.83, p = 0.0007). CBF improvement ranged from 33% to 161% above baseline, average 69.3%. No complications of IABC were observed. CONCLUSIONS: This is the first report demonstrating the ability of IABC to improve CBF in a patient with vasospasm. We suggest that IABC is a rational treatment option in select patients with refractory cerebral vasospasm who do not respond to traditional treatment measures.

Cerebrovascular Circulation↗
PubMed1979

Intra-aortic balloon counterpulsation. Clinical experience.

From March 1975 until September 1978, seventy patients were referred for intra-aortic balloon counterpulsation for cardiogenic shock complicating acute myocardial infarction or for the treatment of low cardiac output states following cardiopulmonary bypass. Sixty of these received adequate intra-aortic balloon pump assistance; fifty-two ped successfully off the balloon pump. Twenty-three patients survived to leave hospital.

Assisted Circulation↗
PubMed1984

New sequential external counterpulsation for the treatment of acute myocardial infarction.

Over a period of 6 years, 52 patients with acute myocardial infarction (AMI) were treated with sequenced external counterpulsation (SECP). Of the 23 patients who experienced severe chest pain, 22 had complete relief within 30 min of SECP, and 31 of the 52 patients showed remarkable improvement in their electrocardiogram after the first hour of treatment. Fifteen patients were studied using the 35-lead ST segment elevation-mapping method. sigma ST and NST, indicators of infarct size, showed decreasing trends in seven patients treated with SECP for a period of 6 days, whereas sigma ST and NST of the control group of eight patients increased during the same period. Our hemodynamic data indicate that in four of five patients with AMI and left heart failure, the central venous pressure and cardiac output increased after SECP, whereas the pulmonary wedge pressure decreased. Measurements of the P-wave terminal force of lead V1 also demonstrated that the application of SECP can improve left ventricular function in a majority of patients with AMI.

Adult↗
PubMed1996

Double balloon catheter for concomitant augmentation of abdominal organ perfusion during intraaortic balloon counterpulsation.

A newly devised double balloon catheter to augment abdominal organ perfusion concomitant with original cardiac assist during intraaortic balloon counterpulsation provided satisfactory hemodynamics and urinary output around cardiac surgical procedures in 2 patients with coronary artery disease. Some optional advantages in clinical application and problems arising in the catheter design which need to be investigated are discussed.

Acetylglucosaminidase↗
PubMed2006

Hemodynamics of a pulsatile left ventricular assist device driven by a counterpulsation pump in a mock circulation.

The BCM (CardialCare, Minneapolis, MN, U.S.A.) is a pusher-plate pulsatile left ventricular assist device (LVAD) that is operated by counterpulsation pumps. The purpose of this work was to assess the fluid dynamics associated with operating the BCM in a mock circulation, and also to examine the similarities between hemodynamic parameters produced by this device in vitro and those produced by the left ventricle (LV) in vivo. The BCM was connected to a true size silicon rubber aorta and operated by an intra-aortic balloon pump. We examined the performance of the device at two system pressures (6.5 and 8 kPa); at three heart rates (60, 80, and 100 bpm); and at three pumping frequencies (1:1, 1:2, 1:3). Pressure and flow were measured in the upper descending aorta, and wave intensity analysis was used to calculate the peak intensity and energy of the compression and expansion waves. Pressure and flow waveforms produced by the BCM LVAD in vitro under different loading conditions were similar to those observed in vivo under similar loadings. Pusher-plate-type LVADs can produce compression and expansion waves similar to those generated by healthy LV in vivo.

Aorta↗