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Al-Ani MA, Snipes G, Parker AM, Kerensky RA. A case of ultra-prolonged intra-aortic balloon pump support via sheathless femoral access. Eur Heart J Case Rep 2023; 7:ytad394. [PMID: 37654803 PMCID: PMC10468013 DOI: 10.1093/ehjcr/ytad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/18/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
Background An intra-aortic balloon pump (IABP) is a mechanical circulatory support platform with a relatively low complication rate. Axillary access is increasingly utilized to allow rehabilitation. Case summary We present a case of femoral IABP inserted into the femoral artery percutaneously via a sheathless technique that allowed the patient to ambulate and physically rehabilitate over 102 days until cardiac transplantation. The patient was able to progress with the protocolized rehabilitation programme to up to 3500 ft walking distance. The IABP was removed at the time of transplantation without any vascular complications. Discussion While axillary IABP offers an opportunity to rehabilitate, it has an unacceptably high complication rate, often resulting in vascular injury that adds morbidity to an acutely ill cohort. In this case, we found that sheathless femoral IABP access offered stability for a prolonged time while avoiding pain, bleeding, infection, and vascular injury. We hypothesize that this is due to less indwelling prosthetic material usage and also device flexibility, allowing conformation to the natural course of the femoral artery. We are encouraged by this case to use a sheathless access approach for patients expected to require prolonged IABP support.
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Affiliation(s)
- Mohammad A Al-Ani
- Division of Cardiovascular Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100288, Gainesville, FL 32608, USA
| | - Garrett Snipes
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alex M Parker
- Division of Cardiovascular Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100288, Gainesville, FL 32608, USA
| | - Richard A Kerensky
- Division of Cardiovascular Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100288, Gainesville, FL 32608, USA
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2
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Vascular complications of prolonged intra-aortic balloon counterpulsation in cardiac surgical patients. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-002-0037-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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3
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Rustum S, Schrimpf C, Haverich A, Aper T, Beckmann E, Wilhelmi M. Intra-aortic balloon pump associated vascular complications in cardiac surgical patients: the past and the future. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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4
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Zhang JM, Liu XC, Liu ZG, Zhao L, Yang L, Liu TW, He GW. Comparison of effects of extra-thoracic paraaortic counterpulsation to intraaortic balloon pump on circulatory support in acute heart failure. J Cardiothorac Surg 2015; 10:173. [PMID: 26602754 PMCID: PMC4659167 DOI: 10.1186/s13019-015-0349-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022] Open
Abstract
Background Previously designed intra-thoracic paraaortic counterpulsation device has limited stroke volume and may depress the lung to cause complications. The purpose of this study was to evaluate the hemodynamic effects of an extra-thoracic paraaortic counterpulsation device (ETPACD) in comparison to intraaortic balloon pump (IABP) in an animal model with acute heart failure. Methods The acute heart failure model was successfully induced by snaring branch of anterior descending coronary artery in sheep (weighting, 38-50 kg, n = 8). The ETPACD is a single port, 65-ml stroke volume blood chamber designed to be connected to descending aorta through a valveless graft and placed extra-thorax. In comparison, a standard clinical 40-ml IABP was placed in the descending aorta. The hemodynamic indices of both devices were recorded during counterpulsation assistance. Two of the sheep were allowed to survive for 1 week to examine the prolonged effect. Results Both ETPACD and IABP increased cardiac output with higher effect of ETPACD (13.52 % vs. 8.19 % in IABP, P < 0.05) and on mean diastolic aortic pressure (26.73 % vs. 12.58 % in IABP, P < 0.01). Both ETPACD and IABP also produced a greater reduction in left ventricular end-diastolic pressure (26.77 % vs. 23.08 %, P > 0.05). The ETPACD increased left carotid artery flow more significantly the IABP (18.00 % vs. 9.19 % , P < 0.05). In two of the sheep allowed to survive for 1 week, the device worked well with no complications and there was no thrombus formation in the chamber of ETPACD. Conclusions This study demonstrated that both ETPACD and IABP provided benefit of circulatory support in acute heart failure with better effect on hemodynamic parameters provided by ETPACD. Therefore, ETPACD with theoretical larger stroke volume may become a promising counterpulsation device for treatment of heart failure.
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Affiliation(s)
- Jie-Min Zhang
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China.
| | - Xiao-Cheng Liu
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China.
| | - Zhi-Gang Liu
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China.
| | - Long Zhao
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China.
| | - Li Yang
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China.
| | - Tian-Wen Liu
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China.
| | - Guo-Wei He
- Center for Circulatory Support and Animal Lab., & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, No.61, the 3rd, TEDA, Tianjin, 300457, China. .,Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
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5
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Capoccia M, Bowles CT, Pepper JR, Banner NR, Simon AR. Evidence of clinical efficacy of counterpulsation therapy methods. Heart Fail Rev 2014; 20:323-35. [DOI: 10.1007/s10741-014-9468-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Dalzell JR, Bhagra SK, Bhagra CJ, Gardner RS. Bridging to heart transplantation with 128 days of intra-aortic balloon pump support. Am J Med 2014; 127:e9-e10. [PMID: 25107383 DOI: 10.1016/j.amjmed.2014.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jonathan R Dalzell
- Scottish Advanced Heart Failure Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom.
| | - Sai K Bhagra
- Department of Cardiology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Catriona J Bhagra
- Department of Cardiology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Roy S Gardner
- Scottish Advanced Heart Failure Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
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7
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Webb CAJ, Weyker PD, Flynn BC. Management of Intra-Aortic Balloon Pumps. Semin Cardiothorac Vasc Anesth 2014; 19:106-21. [DOI: 10.1177/1089253214555026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Giridharan GA, Bartoli CR, Spence PA, Dowling RD, Koenig SC. Counterpulsation with symphony prevents retrograde carotid, aortic, and coronary flows observed with intra-aortic balloon pump support. Artif Organs 2012; 36:600-6. [PMID: 22591355 DOI: 10.1111/j.1525-1594.2012.01456.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A counterpulsation device (Symphony) is being developed to provide long-term circulatory support for advanced heart failure (HF) patients. In acute animal experiments, flow waveform patterns in the aortic, carotid, and coronary arteries were compared during Symphony and intra-aortic balloon pump (IABP) support. Human data were examined for similarities. The 30-mL Symphony was compared to a 40-mL IABP in calves with cardiac dysfunction (80-100 kg, n = 8). Aortic pressures and aortic, carotid, and coronary artery flows were simultaneously recorded at baseline (devices off) and during 1:1 and 1:2 support. Forward, retrograde, and mean flows were calculated and compared for each test condition. Findings were also compared to aortic flow measurements recorded in HF patients (n = 21) supported by 40-mL IABP. IABP caused significant retrograde flows in the aorta, coronary (IABP: -24 ± 8 mL/min, Symphony: -6 ± 2 mL/min, baseline: -2 ± 1 mL/min, P < 0.05), and carotid arteries (IABP: -30 ± 5 mL/min, Symphony: -0 ± 0 mL/min, baseline: -0 ± 0 L/min, P < 0.05) during ventricular systole compared to the Symphony. IABP support produced higher diastolic pressure and flow augmentation compared to Symphony. Due to retrograde flows during IABP support, Symphony provided higher overall coronary, carotid, and aortic flows. Similar reduction in total aortic flows due to retrograde flow was observed in HF patients during IABP support. Counterpulsation with an IABP via aortic volume displacement produces retrograde flows during rapid balloon deflation that reduces total flow. Counterpulsation with Symphony via volume removal eliminates retrograde flow and improves total flow more than that achieved with IABP. The Symphony may provide long-term hemodynamic benefits in HF patients.
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Bartoli CR, Dowling RD. The future of adult cardiac assist devices: novel systems and mechanical circulatory support strategies. Cardiol Clin 2012; 29:559-82. [PMID: 22062206 DOI: 10.1016/j.ccl.2011.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The recent, widespread success of mechanical circulatory support has prompted the development of numerous implantable devices to treat advanced heart failure. It is important to raise awareness of novel device systems, the mechanisms by which they function, and implications for patient management. This article discusses devices that are being developed or are in clinical trials. Devices are categorized as standard full support, less-invasive full support, partial support: rotary pumps, partial support: counterpulsation devices, right ventricular assist device, and total artificial heart. Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined.
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Affiliation(s)
- Carlo R Bartoli
- Department of Physiology and Biophysics, University of Louisville School of Medicine, Louisville, KY, USA
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Bartoli CR, Dowling RD, Wilson GC, Giridharan GA, Slaughter MS, Sherwood LC, Spence PA, Prabhu SD, Koenig SC. Response to Letter to the Editor: A Novel Subcutaneous Counterpulsation Device: Acute Hemodynamic Efficacy During Pharmacologically Induced Hypertension, Hypotension, and Heart Failure. Artif Organs 2011. [DOI: 10.1111/j.1525-1594.2010.01184.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Gjesdal O, Gude E, Arora S, Leivestad T, Andreassen AK, Gullestad L, Aaberge L, Brunvand H, Edvardsen T, Geiran OR, Simonsen S. Intra-aortic balloon counterpulsation as a bridge to heart transplantation does not impair long-term survival. Eur J Heart Fail 2009; 11:709-14. [DOI: 10.1093/eurjhf/hfp078] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ola Gjesdal
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
- Faculty Division Rikshospitalet; University of Oslo; N-0027 Oslo Norway
| | - Einar Gude
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
| | - Satish Arora
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
| | | | | | - Lars Gullestad
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
- Faculty Division Rikshospitalet; University of Oslo; N-0027 Oslo Norway
| | - Lars Aaberge
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
| | - Harald Brunvand
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
| | - Thor Edvardsen
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
- Faculty Division Rikshospitalet; University of Oslo; N-0027 Oslo Norway
| | - Odd R. Geiran
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet; N-0027 Oslo Norway
- Faculty Division Rikshospitalet; University of Oslo; N-0027 Oslo Norway
| | - Svein Simonsen
- Department of Cardiology, Rikshospitalet; N-0027 Oslo Norway
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Acute hemodynamic efficacy of a 32-ml subcutaneous counterpulsation device in a calf model of diminished cardiac function. ASAIO J 2009; 54:578-84. [PMID: 19033769 DOI: 10.1097/mat.0b013e318186891f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The acute hemodynamic efficacy of an implantable counterpulsation device (CPD) was evaluated. The CPD is a valveless single port, 32-ml stroke volume blood chamber designed to be connected to the human axillary artery using a simple surface surgical procedure. Blood is drawn into the pump during systole and ejected during diastole. The acute hemodynamic effects of the 32-ml CPD were compared to a standard clinical 40-ml intra-aortic balloon pump (IABP) in calves (80 kg, n = 10). The calves were treated by a single oral dose of Monensin to produce a model of diminished cardiac function (DCF). The CPD and IABP produced similar increases in cardiac output (6% CPD vs. 5% IABP, p > 0.5) and reduction in left ventricular external work (14% CPD vs. 13% IABP, p > 0.5) compared to DCF (p < 0.05). However, the ratio of diastolic coronary artery flow to left ventricular external work increase from DCF baseline (p < 0.05) was greater with the CPD compared to the IABP (15% vs. 4%, p < 0.05). The CPD also produced a greater reduction in left ventricular myocardial oxygen consumption from DCF baseline (p < 0.05) compared to the IABP (13% vs. 9%, p < 0.05) despite each device providing similar improvements in cardiac output. There was no early indication of hemolysis, thrombus formation, or vascular injury. The CPD provides hemodynamic efficacy equivalent to an IABP and may become a therapeutic option for patients who may benefit from prolonged counterpulsation.
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13
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Christenson JT, Sierra J, Romand JA, Licker M, Kalangos A. Long intraaortic balloon treatment time leads to more vascular complications. Asian Cardiovasc Thorac Ann 2008; 15:408-12. [PMID: 17911069 DOI: 10.1177/021849230701500510] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraaortic balloon counterpulsation is an established and efficient therapy. Limb ischemia is the most common complication. The impact of treatment duration on balloon-related complications was analyzed retrospectively in 135 patients who underwent balloon counterpulsation between 1998 and 2004. Thirty high-risk coronary patients required preoperative intraaortic balloon therapy, 41 were in preoperative cardiogenic shock, and 64 needed support for difficulties in weaning from cardiopulmonary bypass. No balloon-related mortality occurred. The overall balloon-related complication rate was 20/135 (14.8%); 18 had limb ischemia, of whom 6 (4.4%) required vascular interventions. Intraaortic balloon treatment time was significantly longer in patients who developed limb ischemia (99.8 +/- 54.1 h) compared to those who did not (34.4 +/- 30.4 h). Preoperative therapy had short treatment times and few complications. Intraaortic balloon pumping provides effective circulatory support with a low complication rate. A clear relationship was established between duration of treatment and balloon-related complications. Independent risk factors for balloon-related complications were long treatment time, acute myocardial infarction, age over 65 years, and ejection fraction less than 0.30.
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Affiliation(s)
- Jan T Christenson
- Department of Cardiovascular Surgery, University Hospital of Geneva, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
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14
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Turi ZG. Intra-aortic Balloon Counterpulsation. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Koenig SC, Spence PA, Pantalos GM, Dowling RD, Litwak KN. Development and early testing of a simple subcutaneous counterpulsation device. ASAIO J 2006; 52:362-7. [PMID: 16883113 PMCID: PMC2828048 DOI: 10.1097/01.mat.0000227729.70008.66] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The intra-aortic balloon pump has been widely and successfully used as a treatment for cardiac dysfunction, but it only has short-term applications. To overcome this limitation, a superficial counterpulsation device (CPD) is being developed to provide extended counterpulsation support to promote myocardial recovery. The CPD is a valveless, monoport, pneumatically driven, 40-ml sac that is intended to be implanted in a pacemaker-type pocket in the subclavian fossa. The sac is designed to fill in systole and empty during diastole through an outflow graft anastomosed to the subclavian artery. A feasibility study was conducted to investigate acute hemodynamic responses to the CPD in eight calves with diminished cardiac function. The CPD augmented aortic diastolic pressure, reduced left ventricular peak systolic and aortic ejection pressures by up to 18%, and increased diastolic coronary flow by up to 21% and stroke volume by up to 12%. A cadaver fit study demonstrated that the human subclavian artery is a reasonable anastomosis site to consider and that the 40-ml CPD needs to be reduced in size to provide a better anatomical fit. The clinical attractiveness of this approach is that it may provide extended support through a subcutaneous surgical procedure.
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Affiliation(s)
- Steven C Koenig
- Departments of Bioengineering and Surgery, University of Louisville, Louisville, Kentucky, USA
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16
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Giridharan GA, Pantalos GM, Litwak KN, Spence PA, Koenig SC. Predicted hemodynamic benefits of counterpulsation therapy using a superficial surgical approach. ASAIO J 2006; 52:39-46. [PMID: 16436889 PMCID: PMC2849754 DOI: 10.1097/01.mat.0000196522.29376.96] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0-50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure-volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients.
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Affiliation(s)
- Guruprasad A Giridharan
- Cardiovascular Innovation Institute, Departments of Surgery and Bioengineering, University of Louisville, 500 South Floyd Street, Louisville, KY 40202, USA
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Oshima K, Morishita Y, Hinohara H, Kadoi Y, Hayashi Y, Tajima Y, Kunimoto F. Prolonged use for at least 10 days of intraaortic balloon pumping (IABP) for heart failure. Int Heart J 2006; 46:1041-7. [PMID: 16394600 DOI: 10.1536/ihj.46.1041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intraaortic balloon pumping (IABP) is a useful therapy for refractory heart failure. However, the safe duration of this therapy and possible complications due to long-term IABP support remain unclear. In this study, we reviewed retrospectively patients requiring the long-term use of IABP, defined here as 10 days or more, to estimate the background and prognosis of patients undergoing long-term use of IABP. The characteristics and perioperative status were compared between survivors and nonsurvivors. A total of 18 patients including 12 males and 6 females required long-term IABP use. IABP was induced in 13 patients (72%) following cardiac surgery and in 5 without cardiac surgery. The mean duration of IABP support was 17 +/- 7 days. Seven patients survived and 11 died of heart failure and/or associated other organ failure. Multiple organ failure (MOF) was recognized in 10 patients, and the incidence of MOF was significantly (P = 0.005) lower in the survivors (14%) compared to the nonsurvivors (82%). The percentage of postcardiac surgery patients was also significantly (P = 0.027) higher in nonsurvivors (91%) than in survivors (43%). Logistic regression analysis identified MOF and cardiac surgery as independent predictors for death. Femoral arterial-venous fistula was the only IABP-related complication. In patients receiving long-term IABP, attention should be paid to other organ complications associated with heart failure, and the use of other circulatory supports such as PCPS or VAD to avoid MOF should be considered if necessary.
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Abstract
The intraaortic balloon pump (IABP) has been used in cardiac operations since the late 1960s. Over the years, with refinements in technology, its use has expanded; the IABP is now the most commonly used mechanical assist device in cardiac operative procedures. This review provides an evaluation of evidence for the efficacy of IABP use in different clinical scenarios, using the American College of Cardiology/American Heart Association classification of evidence where appropriate. We evaluated complications and outcomes associated with IABP use, and attempted to draw conclusions regarding the use of the IABP in different clinical situations. We examined the trends and variation in utilization over time and across centers. We discussed the IABP in light of new cardiac assist devices and the changing patient population and management strategies. Lastly, we identified areas of future research.
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Affiliation(s)
- Roger J F Baskett
- The Maritime Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
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Minich LL, Tani LY, Hawkins JA, Orsmond GS, Di Russo GB, Shaddy RE. Intra-aortic balloon pumping in children with dilated cardiomyopathy as a bridge to transplantation. J Heart Lung Transplant 2001; 20:750-4. [PMID: 11448803 DOI: 10.1016/s1053-2498(00)00247-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Children with dilated cardiomyopathy awaiting transplantation who fail maximal pharmacologic therapy may benefit from intra-aortic balloon pumping. Between July 1993 and August 1999, a total of 4 children with dilated cardiomyopathy underwent pre-transplant balloon pumping for 6.0 +/- 5.8 (1 to 12) days. One child (pumped for 12 days) died awaiting transplant, and the remaining 3 were successfully transplanted. Intra-aortic balloon pumping timed precisely with M-mode echocardiographic markers offers a relatively simple and safe intermediate level of mechanical support for children with dilated cardiomyopathy who fail pharmacologic support.
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Affiliation(s)
- L L Minich
- Departments of Pediatrics and Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah 84113, USA
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Garrett K, Grady KL. Intraaortic balloon pumping through the common iliac artery: management of the ambulatory intraaortic balloon pump patient. PROGRESS IN CARDIOVASCULAR NURSING 2000; 15:14-20. [PMID: 10723787 DOI: 10.1111/j.0889-7204.2000.80383.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Indications for use of the intraaortic balloon pump have expanded as advances in the treatment of heart disease have continued. The intraaortic balloon pump is the most widely used circulatory assist device inserted as short term or long term therapy. Because the percutaneous femoral artery approach requires bedrest, new techniques for intraaortic balloon pump insertion that allow greater mobility are being developed for patients who require long term ventricular support. The goal of ambulation in these patients is to prevent potential complications associated with prolonged immobility. This paper reviews the use of the common iliac artery as an alternate site for intraaortic balloon pump insertion that allows the patient to ambulate and exercise. Pre and post procedure management as well as potential complications of intraaortic balloon pump insertion are discussed.
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Affiliation(s)
- K Garrett
- Rush University, College of Nursing, Chicago, IL 60612-3832, USA
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