Influence of Intraaortic Balloon Pump Counterpulsation on Transesophageal Echocardiography Derived Determinants of Diastolic Function

Abstract

IntroductionIntraaortic balloon pump counterpulsation (IABP) is often used in patients with acute coronary syndrome for its favourable effects on left ventricular (LV) systolic function and coronary perfusion. However, the effects of IABP on LV diastolic function have not been comprehensively investigated. Acute diastolic dysfunction has been linked to increased morbidity and mortality. The aim of this study was to examine the influence of IABP on LV diastolic dysfunction using standard TEE derived parameters.MethodsIntraoperative TEE was performed in 10 patients (mean age 65 ± 11 yrs) undergoing urgent coronary artery bypass graft surgery (CABG), who had received an IABP preoperatively. TEE derived measures of diastolic dysfunction included early to late transmitral Doppler inflow velocity ratio (E/A), deceleration time (Dt), pulmonary venous systolic to diastolic Doppler velocity ratio (S/D), transmitral propagation velocity (Vp), and the ratio of early to late mitral annular tissue Doppler velocities (e’/a’). Statistical analyses included the Wilcoxon Sign-Rank test, and a p<0.05 was considered significant.ResultsTransmitral inflow E/A ratios increased significantly from 0.86 to 1.07 (p < 0.05), while Dt decreased significantly from 218 to 180 ms (p < 0.05) with the use of IABP. Significant increases in Vp (34 cm/s to 43 cm/s; p < 0.05), and e’/a’ (0.58 to 0.71; p < 0.05) suggested a favourable influence of intraaortic counterpulsation on diastolic function.ConclusionThe use of perioperative IABP significantly improves TEE derived parameters of diastolic function consistent with a favourable impact on LV relaxation in cardiac surgery patients undergoing CABG.

Analysis of Intra-Aortic Balloon Performance in Open-Heart Surgery

“…In patients with cardiac surgery having CABG, the administration of perioperative IABP considerably improves transesophageal echocardiography derived indices of diastolic function, which is consistent with a positive influence on LV relaxation [18]. The risk factors for the preoperative plasma creatinine level in 177 individuals were published in 2021 by Hector Hugo from Mexico.…”

Left Ventricular Assisting Devices in Percutaneous Coronary Intervention

“…Although there is a limitation regarding their small sample size, the researchers concluded IABP counterpulsation has a positive impact on diastolic function in patients undergoing urgent coronary artery bypass grafting (CABG), in addition to the previously-known beneficial effects on systolic dysfunction. 11 A much larger study by the Québec Heart-Lung Institute, Laval University performed a meta-analysis utilizing the data of 22 different observational studies, including a total of 46,067 patients. It assessed the effect of IABP on hospital stay and 30-day mortality, while also looking at the length of stay of patients in the intensive care unit and the need for cardiac surgery.…”

Weaning from IABP after CABG Surgery: Impact of Serum Lactate Levels as an Early Predictor

“…Low cardiac output syndrome is a serious and lifethreatening state after cardiac surgery, which needs proper and effective steps to manage impaired cardiac function (1). Intra-Aortic Balloon Pump (IABP) is the most commonly used temporary mechanical support device perioperatively (2). IABP predominantly reduces Left Ventricular (LV) afterload.…”

“…It also improves myocardial oxygen supply/ demand ratio and LV diastolic function (1)(2)(3). CABG in the setting of severe LV dysfunction, failure to wean from Cardiopulmonary Bypass (CPB), and postoperative low cardiac output syndrome have been suggested as the perioperative indications to use IABP as a bridging device for cardiac transplant and perioperative diastolic dysfunction (2,(4)(5)(6). Up to now, many studies have addressed the indications, complications, and perioperative ►Implication for health policy/practice/research/medical education:…”