Intraoperative Application of Intraaortic Balloon Counterpulsation Determined by Clinical Monitoring of the Endocardial Viability Ratio

Philips, Peter A.; Bregman, David

doi:10.1016/s0003-4975(10)64068-4

Cited by 31 publications

(11 citation statements)

References 12 publications

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“…The hemodynamic recordings were analyzed at baseline and support conditions to obtain indices of LV function and peripheral perfusion. The diastolic pressure time index (DPTI), the area between the aortic pressure signal and LV pressure signal in diastole, was calculated as a measure for diastolic coronary perfusion (15,16). The tension time index (TTI), the enclosed area under the systolic LV pressure curve, was calculated as a measure for LV afterload (15,17,18).…”

Section: Methodsmentioning

confidence: 99%

“…The diastolic pressure time index (DPTI), the area between the aortic pressure signal and LV pressure signal in diastole, was calculated as a measure for diastolic coronary perfusion (15,16). The tension time index (TTI), the enclosed area under the systolic LV pressure curve, was calculated as a measure for LV afterload (15,17,18). The ratio between the two parameters constitutes the endocardial viability ratio DPTI/TTI (%) (15).…”

Section: Methodsmentioning

confidence: 99%

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The Acute Effect of Intra‐aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

et al. 2006

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Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P<0.05/-8%, P<0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P<0.03). Coronary perfusion was increased by additional IABP: CC, Qcor, +9%, and DPTI, +18% (P<0.02); PC, Qcor,+6%, and DPTI, +11% (P<0.05). IABP augmented the myocardial oxygen supply/demand ratios (CC/PC): Qcor/(PVA.heart rate) (+21%/+22%, P<0.02) and DPTI/TTI (+27%/+24%, P<0.03). In case of low arterial pressure (<50 mm Hg) and reduced ECLS flow, the overall hemodynamic profile improved only with central cannulation. We conclude that in both central and peripheral ECLS cannulation settings, adjunctive IABP improves the myocardial oxygen supply demand balance. In case of low cardiac output and insufficient extracorporeal flow with PC, adjunctive IABP may be contraindicated.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Acute Effect of Intra‐aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

et al. 2006

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“…Besides supporting the circulation, aortic counterpulsation exerts favorable effects on the injured myocardium. First, unloading of the failing ventricle decreases myocardial oxygen demands 13 . Second, the augmentation of diastolic aortic pressure can increase the coronary arterial blood flow.…”

Section: Pathophysiologic Considerationsmentioning

confidence: 99%

“…First, unloading of the failing ventricle decreases myocardial oxygen demands. 13 Second, the augmentation of diastolic aortic pressure can increase the coronary arterial blood flow. Since the latter remains constant by autoregulation within perfusion pressures ranging from 45 to 125 mm Hg, it is increased by the IABP in the presence of very low perfusion pressures or when coronary arterial autoregulation is impaired.…”

Section: Pathophysiologic Considerationsmentioning

confidence: 99%

Intra‐Aortic Balloon Counterpulsation for the Treatment of Myocardial Infarction Complicated by Acute Severe Heart Failure

Tsagalou

Anastasiou-Nana

Nanas

2009

Congestive Heart Failure

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Intractable heart failure (HF) remains a leading fatal complication of acute myocardial infarction (AMI). Intra-aortic balloon pump (IABP) counterpulsation assists the failing left ventricle and accelerates the functional recovery of stunned myocardium. Despite its remarkable performance, the beneficial effects of the IABP in the setting of acute HF or cardiogenic shock complicating AMI have not been confirmed in a randomized clinical trial. Instead, large amounts of information have been collected in observational studies or in retrospective analyses of randomized trials of reperfusion strategies in patients with AMI. The strategy of "stabilize with IABP, treat with reperfusion, and transfer for complete revascularization" has, thus far, yielded the best outcomes, and every effort should be made to implement this strategy in all patients presenting with AMI and severe HF.

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“…Using the IABP in patients with acute myocardial infarction with complications, such as cardiogenic shock, without any subsequent plan for surgery, has been shown to be less valuable. In a review of balloon pumping in 401 patients for cardiogenic shock who did not undergo surgery, the overall survival was 28% (113/401) with a range of 11 to 71%.4-14 In 24 recent studies in the literature, 1543 IABP patients treated both medically and surgically had an overall hospital survival of 50% (776/1543).4° 11-~3~ [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Most authors stressed the importance of early IABP in the treatment of cardiogenic shock and also pointed out better results in surgically managed cardiac patients, both pre-and postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Intraaortic Balloon Counterpulsation: A Review

et al. 1978

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The intraaortic balloon counterpulsation pump (IABP) was successfully placed in 54 patients from 1972 to January 1978. Total overall survival was 46% (25/54). In the past 3 years survival was doubled (54% — 21/39) compared to the initial experience from 1972 through 1975 (27% — 4/15). Eleven percent (6/54) of the patients died after the IABP was removed, 19% (10/54) became balloon-dependent, and 24% (13/54) had either a poor response or no response to IABP.Indications for IABP were cardiogenic shock secondary to myocardial infarction (CS-MI), preinfarction angina, postoperative cardiopulmonary bypass dependency (CPBD), the most common indication, or post cardiotomy cardiogenic shock. Preoperative prophylactic placement of the balloon was used in 7 patients with a 57% (4/7) survival. None of the 10 patients treated for CS-MI survived to discharge. Fifty-one percent (18/35) of CPBD patients were long-term survivors.Complications including difficulty passing the device (15/54), thrombosis (6/54), minor dissection (3/54), or combinations of these problems occurred in 41% (22/54) of the patients. Hemodynamic and metabolic parameters were also reviewed. Early recognition of cardiogenic shock and prompt placement of the IABP are essential to insure decreased morbidity and increased survival in these critically ill patients.

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Intraoperative Application of Intraaortic Balloon Counterpulsation Determined by Clinical Monitoring of the Endocardial Viability Ratio

Cited by 31 publications

References 12 publications

The Acute Effect of Intra‐aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

The Acute Effect of Intra‐aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

Intra‐Aortic Balloon Counterpulsation for the Treatment of Myocardial Infarction Complicated by Acute Severe Heart Failure

Intraaortic Balloon Counterpulsation: A Review

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