Hemodynamic Evaluation of Intra-Aortic Balloon Pumping in Man
TL;DR: The findings suggest that this intra-aortic balloon pumping system is a safe means of assisting the failing left ventricle and the high mortality in this series is related to the extent of irreversible myocardial damage which may be reduced by more aggressive, earlier application of counterpulsation.
Abstract: Intra-aortic balloon pumping is effective in reducing left ventricular peak systolic pressure and increasing cardiac output in patients with severe cardiogenic shock secondary to acute myocardial infarction. Associated with these effects is a reduction in intravenous catecholamine requirements and increased sensitivity to diuretics. Reduction in left ventricular end-diastolic pressure is implied by improvement in arterial blood gas saturation (reduced arterioalveolar gradient) and was shown directly in one patient. Total myocardial oxygen consumption is probably reduced by counterpulsation. Platelet levels have not fallen significantly with adequate heparinization and the slow infusion of low molecular weight dextran. No complications have occurred related to femoral artery cannulation, nor has there been significant damage to the aorta. The findings suggest that this system is a safe means of assisting the failing left ventricle. The high mortality in this series (seven of eight patients) is related to t...
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TL;DR: There is a high in-hospital mortality rate when CS develops as a result of VSR, and women and the elderly may be more susceptible, although the prognosis is poor.
320 citations
Cites background from "Hemodynamic Evaluation of Intra-Aor..."
...The recognized limitations of medical management (8,9), the availability of the IABP (10) and improvements in surgical technique and myocardial protection soon led to aggressive surgical management for most patients with VSR (11,12)....
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...Right ventricular systolic pressure (mm Hg) 56 6 21 (10) 46 6 20 (124) 0....
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...The VSR group was more likely to receive IABP support....
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...Right ventricular diastolic pressure (mm Hg) 20 6 6 (10) 15 6 10 (118) 0....
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...Vasopressor therapy was given to 97% (36/37) of VSR patients; 75% (41/55) were mechanically ventilated; and intra-aortic balloon pump (IABP) was inserted in 75% (41/55)....
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TL;DR: IABP is a safe, effective means of supporting the circulation in CS-MI, and IABP alone will improve survival in some patients, and some patients with CS- MI have myocardial necrosis too extensive to permit survival without permanent circulatory assistance or total cardiac replacement.
Abstract: The AVCO balloon pump has been employed in treating 40 patients with cardiogenic shock from acute myocardial infarction (CS-MI). All patients were given a trial of medical therapy with hemodynamic monitoring. The time from the development of shock to institution of intraaortic balloon pumping (IABP) was less than 24 hours in all but nine patients. Prior to IABP the mean hemodynamic values were: cardiac index (CI) 1.7 liters/min/m2; mean arterial pressure (MAP) 66 mm Hg; pulmonary artery wedge pressure (PAW) 22 mm Hg. After 24-48 hours of IABP the CI and MAP had increased 0.8 liters/min/m2 and 8 mm Hg, respectively, and the PAW had decreased 4.8 mm Hg. During IABP the shock syndrome was reversed in 31 patients. Four of 25 patients treated with IABP alone survived to be discharged, but two have died from subsequent infarctions. Because of the persistent high mortality, 15 patients judged unable to survive off IABP have undergone emergency surgical procedures with IABP continuing during preoperative angiogra...
249 citations
TL;DR: This review summarizes the major aspects and current status of the IAB, which has been used in the treatment of several hundred patients with acute myocardial infarction shock and other conditions complicating the course of ischemic heart disease and characterized by low-output failure.
192 citations
TL;DR: The effects of intraaortic balloon counterpulsation (IABC) on the magnitude and severity of myocardial ischemic injury were studied in 19 dogs following acute coronary occlusion and in two patients with cardiogenic shock, and preliminary observations in these patients confirmed the experimental results indicating that IABC reduced myocardia isChemic injury.
Abstract: The effects of intraaortic balloon counterpulsation (IABC) on the magnitude and severity of myocardial ischemic injury were studied in 19 dogs following acute coronary occlusion and in two patients with cardiogenic shock. In the experimental group, epicardial electrocardiograms were taken from 10-14 sites on the anterior surface of the left ventricle following occlusion of the left anterior descending coronary artery or its apical branch. The average S-T-segment elevation ([see Equation in PDF File]) was used as an index of the magnitude of myocardial ischemic injury. In six dogs, two successive 20-min occlusions were performed, and IABC was started prior to the second occlusion. [see Equation in PDF File] 15 min following occlusion decreased from 3.3 ± 0.9 mv after the control occlusion to 1.4 ± 0.4 mv (P < 0.01) after the occlusion with IABC. In three dogs in which the occlusion was maintained and IABC initiated 30 min later, [see Equation in PDF File] decreased from 1.2 to 0.6 mv. In six dogs in which ...
185 citations
01 Feb 2010
TL;DR: Patients who transition to advanced stages of disease despite optimal traditional medical and device therapy may be candidates for hemodynamically directed approaches such as a left ventricular assist device; in selected cases, listing for cardiac transplant may be warranted.
Abstract: Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF involves identification and correction of potentially reversible precipitants, target-dose titration of medical therapy, and management of hospitalizations for decompensation. The etiological phenotype, absolute decrease in left ventricular ejection fraction and a widening of QRS duration on electrocardiography, is commonly used to identify patients at increased risk of progression of heart failure and sudden death who may benefit from prophylactic implantable cardioverter-defibrillator placement with or without cardiac resynchronization therapy. Patients who transition to advanced stages of disease despite optimal traditional medical and device therapy may be candidates for hemodynamically directed approaches such as a left ventricular assist device; in selected cases, listing for cardiac transplant may be warranted.
182 citations
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TL;DR: It is hoped that the use of this device in the failing heart will result in increased diastolic blood flow, improved coronary perfusion, and decreased work for the failing left ventricle.
445 citations
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