Evidence of clinical efficacy of counterpulsation therapy methods

Abstract

Although heart transplantation remains the ultimate treatment for end-stage heart failure, its epidemiological impact is limited by donor organ availability. Surgical and device-based approaches have been introduced with the aim of increasing systemic perfusion and in some circumstances promoting left ventricular recovery by inducing reverse remodelling. Innovative counterpulsation devices based on the established principle of the intra-aortic balloon pump have been developed, and of these, the CardioVad and the C-Pulse System have been introduced in clinical practice with convincing evidence of haemodynamic efficacy. The evolution from pulsatile to continuous-flow left ventricular assist devices has been associated with improved survival rates during the first 2 years of support with the potential of matching heart transplantation outcomes. However, blood contact with the device remains a significant challenge despite the highly sophisticated technology currently available. Innovative extra-vascular counterpulsation devices have been shown to overcome the limitations of the intra-aortic balloon pump and rend the device suitable for prolonged support. Monitoring of the performance of these novel devices is essential, and carotid Doppler ultrasonography is of utility in assessing the haemodynamic performance of the devices in a clinical setting. Computational modelling has played a role in the simulation of these devices and should continue to assist with their optimisation and implementation in clinical practice.

Synchronizing Gait with Cardiac Cycle Phase Alters Heart Rate Response during Running

“…These values and tolerances were chosen based on data collected previously by authors JLB and PDM (unpublished) that evaluated HR response to stepping at a variety of targets in the RRI, wherein the %RRI at minimum HR (optimal timing) and the %RRI at maximum HR (least advantageous timing) were identified. The early diastolic target timing of 45% of the RRI is consistent with the timing of mechanical counterpulsation technologies used regularly in the clinical setting, including intra-aortic balloon counterpulsation, left ventricular assist device counterpulsation, and external counterpulsation ( 21 – 23 ). Optimal timing of the musculoskeletal pump during the gait cycle, similar to the preferred timing of clinical counterpulsation therapies, is immediately after aortic valve closure during the heart’s pump cycle, when intra-aortic blood pressure first exceeds intra ventricular pressure ( 3 ).…”

Hemodynamic Impact of the C‐Pulse Cardiac Support Device: A One‐Dimensional Arterial Model Study

“…One of the well‐established counterpulsation therapies for temporary left ventricular support in acutely ill patients is the intraaortic balloon pump (IABP) . Despite the clinical benefits of this device in patients with an acute need for cardiac support , the IABP still has some inherent limitations because of its blood contacting nature, requiring an intravascular catheter which presents risks of infection, thromboembolic complications, and lower limb vascular insufficiency . Also, long‐term support with IABP is practically not feasible, as well as mobility of patients, and the paucity of data supporting the use of this device in certain populations with myocardial infarction has been highlighted in the literature .…”

Migration of Guidewire: A Rare Complication during Arterial Cannulation in a Patient on Intra-arterial Balloon Pump

“…3). A similar case can also be found in the study by Capoccia et al 7 The beneficial mechanism of IABP has been proposed to use wave intensity analysis (WIA). 6 WIA is a method that differentiates between forward running waves propagating in same direction and backward running waves moving in opposite direction.…”