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PubMedDate not supplied

Transesophageal echocardiographic evaluation of left ventricular function during intraaortic balloon pump counterpulsation.

Transesophageal echocardiography was used to study the effects of intraaortic balloon pump counter pulsation (IABP) on left ventricular dimensions and function in 16 hypotensive patients after cardiac surgery. The short-axis cross section at midpapillary muscle level was used to determine systolic and diastolic dimensions. We found a significant decrease in end-systolic and end-diastolic area and increase in fractional area change during IABP-supported circulation. Regional area ejection fraction analysis demonstrated an improvement during IABP of impaired (particularly severely impaired) function at baseline. We conclude that both regional and global left ventricular function improve by the use of IABP in conjunction with a decrease of left ventricular size.

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PubMed2003

The role of the intra-aortic balloon pump counterpulsation (IABP) in emergency surgery.

Elective surgical procedures are often delayed for up to six months in patients who have suffered a myocardial infarction (MI) because of the substantial risk of re-infarction and high peri-operative mortality. The optimal management of patients who have sustained a recent myocardial infarction and who require an emergency abdominal operation, however, has yet to be defined. The use of an intraaortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. Three cases are presented in which IABP was used in patients who had recently sustained a myocardial infarction and who required emergency abdominal surgery. A review of the literature is presented and the application of IABP in such circumstances is discussed. Although clinical experience is limited, the use of the IABP may be useful in selected patients who have sustained a recent MI and who require emergency surgery.

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PubMed2006

Effects of intra-aortic balloon counterpulsation on parameters of tissue oxygenation.

BACKGROUND AND OBJECTIVE: To investigate the effects of intra-aortic balloon pump therapy on parameters of global and regional oxygenation in patients undergoing cardiac surgery. METHODS: As part of a large surveillance study in cardiac surgery patients (n=266) we retrospectively analyzed the course of 28 patients requiring intra-aortic balloon pump therapy. Patients were grouped according to the time point of pump insertion (during weaning from cardiopulmonary bypass: group early intra-aortic balloon pumping (n=17); after admission to the intensive care unit: group late intra-aortic balloon pumping (n=9). Haemodynamic and tonometric variables, arterial lactate, and use of catecholamines were measured hourly. MEASUREMENTS AND RESULTS: Cardiac index increased in both groups after intra-aortic balloon pump insertion (2.2+/-0.5 baseline; 3.4+/-0.8 L min-1 m-2 4 h later (group early intra-aortic balloon pumping); 2.8+/-0.5 baseline, 3.6+/-L min-1 m-2 4 h later (group later intra-aortic balloon pumping), each P<0.05), there were no differences between groups. Arterial lactate values increased in group later intra-aortic balloon pumping after pump insertion to a maximum 2 h later (8.4+/-6.1 mmol L-1 baseline; 12.7+/-7.4 mmol L-1, P<0.05), and decreased continuously afterwards. The difference of arterial and gastric CO2 showed a sharp decrease after pump insertion in group later intra-aortic balloon pumping (26.4+/-9.8 baseline; 7.0+/-11.1 mmHg, P<0.05). There were no differences between groups. Epinephrine doses were higher in group later intra-aortic balloon pumping (P<0.05). CONCLUSIONS: Intra-aortic balloon pump therapy improved global and regional splanchnic oxygenation in cardiac surgery patients with low-cardiac-output syndrome. Gastro-intestinal tonometry could provide additional information concerning tissue oxygenation. Patients with later intra-aortic balloon pump insertion needed more catecholamine therapy to achieve similar haemodynamic values.

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PubMed2000

[Endothelial lesions caused by intra-aortic counterpulsation balloons].

Intra-aortic balloon pump (IABP) is the most frequently used mechanical circulatory support. Repeated trauma on the aortic wall has been reported as a cause of balloon perforation by endothelial denudation of atheromatous plaque. This study analyses the effect of IABP on the endothelium of the calf aorta. In 12 calves (mean weight: 72 +/- 6 kg) an IABP was inserted by femoral route and left during 6 hours on internal mode with a frequency of 80 cycles/min. The animals were sacrificed after the procedure (n = 4), at postoperative day (POD) 7 (n = 4), and at POD 14 (n = 4). In the aorta facing the balloon, nine transmural samples were taken proximally (n = 3), at mid height (n = 3) and distally (n = 3), for histological analysis of the percentage of aortic surface covered with endothelium. The percentage of aortic surface covered with endothelium at POD 0, 7 and 14 was proximally: 72.5 +/- 27.5%, 83.7 +/- 16.9% and 93.3 +/- 8.9% respectively; at mid-height: 50.8 +/- 30.7%, 65 +/- 25% and 95 +/- 5%; and distally: 31.4 +/- 20.1%, 48.3 +/- 34.4% and 85 +/- 10%. A large portion of the aortic endothelium is abraded after 6 hours of IAB pumping. This effect is more important at the distal level of the aorta. After two weeks, most of the endothelium has regenerated.

Animals↗
PubMedDate not supplied

The role of intra-aortic counterpulsation in high-risk OPCAB surgery: a prospective randomized study.

BACKGROUND: High-risk patients would benefit the most of OPCAB revascularization. This prospective and randomized study evaluates the efficacy and safety of pre- and perioperative IABC in high-risk OPCAB. MATERIAL: Group A-IABC started prior to induction of anesthesia (n = 15); group B-no preoperative IABC (n = 15). Adult high-risk coronary patients to undergo OPCAB. High risk = (minimum 2) EF < 0.30, left main stenosis, unstable angina, redo. Bailout if hemodynamic instability CPB or IABC in group B. Study endpoints (a) cardiac protection (troponin 1, cardiac index (CI), ECG), (b) inflammatory response (lactate, IL-6), (c) clinical outcome (mortality, morbidity). Emergency operations 33%, re-operation 13%, unstable angina 100%, left main 60% and EF 0.29, without group differences. RESULTS: No bailout group A, 10 in group B, p < 0.0001. Postoperative IABC six (group A) and seven patients (group B), during 6.8 +/- 5.1 hours (group A) versus 41.2 +/- 25.5 hours (group B), p = 0.0110. Myocardial protection without group differences, but CI significantly better in group A. Inflammatory response significantly less in group A. CLINICAL OUTCOMES: one death, one MI and two renal failure in group B, none in group A. Intensive care unit (ICU) stay 27 +/- 3 hours (group A) versus 65 +/- 28 hours (group B), p = 0.0017. LOS 8 +/- 2 days (group A) versus 15 +/- 10 (group B), p = 0.0351. No IABC related complications. CONCLUSIONS: Pre- and perioperative IABC therapy offers efficient hemodynamic support during high-risk OPCAB surgery, lowers the risk of hemodynamic instability, is safe and shortens both ICU and hospital length of stay significantly, and is a cost-effective therapy.

Cardiopulmonary Bypass↗
PubMed2001

Intra-aortic balloon counterpulsation: outcome in cardiac surgical patients.

OBJECTIVE: To identify the major determinants of survival and nonsurvival for patients in need of intra-aortic balloon pump (IABP) support after cardiac surgery and to define the role of ventilator-associated pneumonia. DESIGN: Retrospective study. SETTING: University and general hospital. PARTICIPANTS: A total of 105 consecutive patients undergoing cardiac surgery requiring IABP support and prolonged mechanical ventilation for >24 hours. INTERVENTION: All patients were assigned into 1 of 2 groups: survival (n = 69) and nonsurvival (n = 36). MEASUREMENTS AND MAIN RESULTS: Differences between the survival and nonsurvival groups were tested with the Student's t-test, chi-square test, and frequency analysis. The overall survival rate was 65.7%. Nonsurvivors (34.3%) had higher rates of acute myocardial infarction (27.7% v 4.3%; p < 0.002), Canadian Cardiovascular Society functional class III and IV (44.4% and 13.8%; p < 0.001), and depressed left ventricular ejection fraction (31.3 +/- 6.4% v 42.4 +/- 7.2%; p < 0.001). The nonsurvival group had longer duration of cardiopulmonary bypass (165 +/- 74.3 minutes v 135 +/- 36 minutes; p < 0.006) and aortic occlusion (81.8 +/- 9 minutes v 68.6 +/- 25.7 minutes; p < 0.004). In the nonsurvival group, 21 patients were not weaned from the IABP, and 15 patients were weaned from the IABP but died from renal failure (26.6%), multiorgan failure (13.3%), infection, and respiratory failure (66.6%). In the nonsurvival group, mechanical ventilation time was longer in patients weaned from the IABP. CONCLUSION: These data suggest that for patients not weaned from the IABP, the major determinants of death are low cardiac output (33.3%) and multiorgan failure (47.6%). Patients with a left ventricular ejection fraction of <30% have a poorer outcome. In patients weaned from the IABP, ventilator-associated pneumonia (66.6%) was the major cause of death.

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PubMed1975

[Effect of intraaortic-ballon-counterpulsation on the changes of myocardial blood flow following coronary artery stenosis and occlusion (author's transl)].

To prove the effectiveness of the IABP in case of impending myocardial infarction in one series of experiments myocardial blood flow changes due to IABP in dogs with stenosis of the left circumflex coronary artery (LC) were investigated using tracer microspheres. In a control series the left anterior descending artery (LAD) was occluded. In acute LAD occlusion the IABP caused an increase of blood flow in the epicardial layer. In case of LC stenosis there was a far greater increase in blood flow by the IABP most prominent in the endocardial layer. Our experiments indicate that the IABP seems to be effective in impending myocardial infarction.

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