Intraaortic Balloon Pumping in Patients with Right Ventricular Insufficiency after Cardiac Surgery: Parameters to Predict Failure of IABP Support

Abstract

In patients with IABP support for postcardiotomy cardiogenic shock, elevated serum lactate, elevated base deficit, hypotension, oliguria and large vasopressor doses are all predictors of mortality. In these patients, the use of another mechanical assist device should be considered in good time. Our study additionally shows that LCOS caused by predominantly right ventricular failure - particularly after CABG - may be an additional indication for IABP.

Right side of heart failure

“…Intra-aortic balloon pumps improved RV function in sheep where RV failure was induced by increasing RV afterload [113]. Intra-aortic balloon counterpulsation in low output syndromes due to RV failure resulted in increased cardiac output and decreased wedge pressure [114][115][116]. However, a later study demonstrated improvement in cardiac output but no improvement in RVEF or LVEF [116].…”

The Evaluation of Preoperative Right Ventricular Diastolic Dysfunction on Coronary Artery Disease Patients with Left Ventricular Dysfunction

“…Hypotension and/or shock following CABG surgery can be attributed to the significant decrease in postoperative RV function . Our previous study also demonstrated that patients with preoperative decreased RV function tended to experience hypotension and/or shock in the early stages after CABG surgery.…”

Summary of the consensus document: “Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery”

“…The indication in this case is subject to important controversy, 84,85 though there are experiences that report an increase in CI and mean blood pressure (MBP) within one hour after insertion, and with a high disconnection (75%) and hospital survival rate (69%). This benefit has been related to the diastolic increase in blood flow to the right coronary artery, which may improve ventricle function, and to the reduction in systemic vascular resistance which can indirectly increase the contractile capacity of the right ventricle.…”

“…There are a series of useful prognostic scales or clinical and biochemical markers allowing us to predict the success or failure of IABP on an early basis. In this sense, Boeken et al 84 When is an intraaortic counterpulsation balloon pump contraindicated in the heart surgery patient?…”