Intra‐aortic Balloon Pump‐induced Pulsatile Flow Reduces Coagulative and Fibrinolytic Response to Cardiopulmonary Bypass

Abstract

The aim of this study is to evaluate if a simple intra-aortic balloon pump (IABP)-induced pulsatile perfusion reduces activation of coagulative system during cardiopulmonary bypass (CPB). Ninety-six patients undergoing preoperative IABP were randomized to nonpulsatile CPB with IABP discontinued during cardioplegic arrest (Group A) or IABP-induced pulsatile CPB (Group B). White blood cells (WBC), hematocrit (Ht), platelets (PLTs), International Normalized Ratio (INR), fibrinogen, activated partial thromboplastin time (aPTT), antithrombin III (AT-III) activity, and D-dimer were measured at the end of surgery (ES) and postoperatively. Chest drainage, need for reexploration, and transfusions were compared. Group B showed lower chest drainage (1st day P = 0.038; 2nd day P = 0.044), transfusions (P = 0.031), WBC (P < 0.05 at all time points), and INR (P < 0.05 at all time points), together with a higher Ht (P < 0.05 at ES, 12 h), platelets (P < 0.04 at all time points), fibrinogen (P < 0.05 at ES, 12 h, 24 h), and aPTT (P < 0.05 at all time points). AT-III activity lowered in Group A (P = 0.001 at ES, 12 h, 24 h), together with higher D-dimer levels (P < 0.05 at all time points). IABP-induced pulsatile perfusion ameliorates coagulative system activation following CPB.

Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion

“…Recent studies have focused not only on the beneficial effects of preoperative IABP deployment in high-risk patients undergoing coronary artery bypass grafting operations [8,9] but also on the continuation of IABPinduced pulsatile perfusion during CPB and cardioplegic arrest [10][11][12] because it contributes to better renal, hepatic, and pancreatic preservation [10], more favorable regional and global perfusion during CPB and throughout the early postoperative period [11], reduced coagulative and fibrinolytic response to CPB [12], and improved lung function in patients with obstructive pulmonary disease [13]. In contrast to these results, Voss and colleagues [2] recently concluded that efforts to obtain pulsatility were not justified because capillary leak and hemolysis was higher than during nonpulsatile CPB perfusion.…”

“…Our animal model resembles IABP application as previously used in clinical and experimental studies with and without CPB [10][11][12][21][22][23]. An IABP balloon of 25 mL was chosen to ensure conditions as previously described [21][22][23].…”

“…A number of more recent studies have focused not only on the beneficial effects of preoperative IABP application in high-risk patients allocated to coronary bypass operations [8,9] but also on prolongation of fixed-rate IABP counterpulsation during cardiac operations because it contributes to improve whole-body perfusion, vital organ preservation, and reduced coagulative and fibrinolytic response [10][11][12][13]. In addition, pulsatility per se preserves endothelial nitric oxide release [14].…”

Preoperative statins improve recovery of renal function but not by an anti-inflammatory effect: observational study in 69 elderly patients undergoing cardiac surgery

“…CPB and surgical techniques were standardized and did not change during the study period. All patients received linear CPB [11][12][13]. In all patients, CABG was performed through a median sternotomy.…”

Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response

“…The recent literature has reported a beneficial impact of OPCABG on endothelial activation and SIRS [3,4]. Moreover, although non-pulsatile blood flow obtained with standard CPB circuits is considered an acceptable, non-physiologic compromise conferring few disadvantages (including lack of induction of the inflammatory response) [1,4], we have reported beneficial effects on splanchnic, renal, respiratory and haemostatic functions when intra-aortic balloon pump (IABP)-induced pulsatile perfusion has been employed in routine coronary surgery [5,6]. The relative effects of all of these options on endothelial activation, inflammatory responses and clinical outcomes are unknown, however.…”