A New Approach to Assist Postoperative Heart Failure in an Animal Model: Juxta‐Aortic Counterpulsation

Abstract

Aortic counterpulsation is a useful technique frequently used in postcardiotomy heart failure. An acute heart failure model in open chest sheep was chosen to evaluate hemodynamic improvement with a counterpulsation balloon pump in juxta‐aortic position. This was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the aorta. Juxta‐aortic balloon pump counterpulsation in acute experimental heart failure resulted in a significant improvement of hemodynamic parameters: increase of cardiac output (from 0.86 ± 0.04 to 1.29 ± 0.09 L/min, p < 0.05) and cardiac index (from 0.03 ± 0.01 to 0.04 ± 0.01 L/min per kg, p < 0.05), and decrease of systemic vascular resistance (from 89.76 ± 6.69 to 66.56 ± 6.02 mm Hg/L per min, p < 0.05). The extent of aortic diastolic pressure change evaluated through the diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index before cardiac failure induction showed a significant increase compared with unassisted values (from 0.81 ± 0.10 to 1.12 ± 0.09, p < 0.05). Assisted values of DABAC/SABAC index after heart failure induction also showed a significant increase compared with unassisted values (from 0.78 ± 0.21 to 1.17 ± 0.38, p < 0.05). Treatment of experimental acute heart failure by juxta‐aortic balloon pump counterpulsation allows an effective hemodynamic improvement in open chest sheep.

New Aspects on the Role of Blood Pressure and Arterial Stiffness in Mechanical Assistance by Intra‐aortic Balloon Pump: In‐vitro Data and Their Application in Clinical Practice

“…For instance, para-aortic balloon pumping provides larger counterpulsation volumes and thus enhanced hemodynamic effects compared to IABP (25). Also, juxta-aortic counterpulsation is another technique almost independent of the compliance of the descending aorta; this method is based on the placement of the balloon in the ascending aorta, which is wrapped with a modified Dacron prosthesis (26).…”

Assessment of Intra‐Aortic Counterpulsation in an Animal Model of Heart Failure and Myocardial Ischemia

“…Regarding the methods used to quantify the effectiveness of IABP, there is a physiological factor about the DABAC/SABAC ratio that should be considered. As in previous works of our group and other authors (12,13,15), the interpretation of the values of DABAC/SABAC was restricted by the fact that a closed relationship with the DPTI/TTI index had been found (12). In other words, Buckberg showed that the DPTI/TTI ratio was an expression of the supply and demand of oxygen to the ventricular myocardium (11), and we found that the DABAC/ SABAC ratio had a close relationship to it, in an animal model of cardiac failure treated with IABP (12).…”

Juxtaaortic Counterpulsation: Comparison with Intraaortic Counterpulsation in an Animal Model of Acute Heart Failure

“…7,12 In 2002, we reported that JABC obtained through an extraarterial catheter balloon positioned between the ascending aorta and aortic arch and a Dacron prosthesis provided adequate circulatory support in experimental animals with induced heart failure. 8 This technique offered the advantage of avoiding the troublesome blood biomaterial interface problem.…”

“…The ascending aorta and the aortic arch were wrapped using a Dacron prosthesis manufactured in our laboratory, according to the technique previously described, as shown in Figure 1. 8 This prosthesis consisted of three Dacron bands 2.5 cm wide and 15 cm long, each sutured with size 6 Silk. The indemnity of the aortic adventitia was preserved and a 9.5 French balloon catheter was positioned in a juxtaaortic position (Datascope Corp., Cardiac Assist Division, NJ; 40 ml counterpulsation balloon) between the inelastic prosthesis and the aorta.…”

“…7 In 2002, we reported a new method to obtain aortic counterpulsation in an animal model of heart failure by using a Dacron prosthesis wrapped around the ascending aorta and the aortic arch and a catheter balloon positioned between the prosthesis and the vessel. 8 This catheter balloon was positioned along the ascending aorta and aortic arch through insertion into the second intercostal space. This technique offers the advantage of avoiding the troublesome blood-biomaterial interface problem and may be appropriate in the early postcardiotomy period, before chest closing, in patients with contraindications for femoral insertion of the catheter balloon.…”