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Teaima T, Gajjar R, Jha V, Aziz I, Shoura S, Shilbayeh AR, Battikh N, Sqour H, Gomez-Valencia J. Impact of right ventricular dysfunction on outcomes in patients requiring intra-aortic balloon pump placement: A retrospective nationwide analysis (2016-2020). Curr Probl Cardiol 2024; 49:102611. [PMID: 38701997 DOI: 10.1016/j.cpcardiol.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
Right ventricular dysfunction (RVD) continues to be a significant contributor to both mortality and morbidity, posing a significant challenge in the management of patients undergoing evaluation for mechanical circulatory support (MCS). Currently, there is a paucity of data regarding outcomes in this subset of patients. We analyzed the National Inpatient Sample database (NIS) to identify adult hospitalizations who underwent intra-aortic balloon pump (IABP) placement with or without co-existence of RVD. Multivariate logistic regression, and linear regression analyses were used to compare outcomes, and adjust for possible confounders. Out of 126,985 hospitalizations who underwent IABP placement, 1,475 (1.2%) had RVD. Patients with RVD who received an IABP had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 2.33, 95% confidence interval [CI]: 1.7-3.2, p<0.001) than those without co-existing RVD. Hospitalized patients who underwent IABP placement with RVD had higher adjusted odds of worse hospitalization outcomes in general. Conducting additional prospective studies and clinical trials with an emphasis on further subcategorization of patients with RVD is crucial for determining optimal management strategies for these patients.
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Affiliation(s)
- Taha Teaima
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Rohan Gajjar
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Vivek Jha
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Imran Aziz
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Sami Shoura
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Abdul-Rahim Shilbayeh
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Naim Battikh
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Hasan Sqour
- Department of Medicine, Ascension Illinois Saint Joseph hospital, Chicago, IL, USA
| | - Javier Gomez-Valencia
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
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Saczkowski R, Spada S, Hromadnik K. Perfusionist removal of intra-aortic balloon pump catheters improves efficiency without an increase in complication rates. Perfusion 2024; 39:506-513. [PMID: 36749309 DOI: 10.1177/02676591221149858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The intra-aortic balloon pump (IABP) is one of the most utilized cardiac assist devices. Patients receiving IABP therapy are typically managed in high acuity clinical care areas with limited bed space and high demand. Our center instituted a certified clinical perfusionist (CCP) led initiative to remove IABP catheters in order to reduce IABP therapy time, hasten removal and improve efficiency. METHODS The purpose of the study is to compare outcomes for IABP removal by a certified clinical perfusionist to a physician. The primary outcome measures were site hematoma score and limb related complications. A survey was submitted to bedside nurses, managers/patient care coordinators, CCP's and physicians. The IABP quality assurance database was interrogated for the study. RESULTS There were 350 patients eligible for inclusion. The cohort was well balanced between CCP (n = 284) and physician (n = 66) groups for patient demographics, indication, insertion specifics and type of medical intervention. The majority of patients had no bruise or hematoma with perfusionist (n = 246, 87%) or physician (n = 58, 88%) (p = 0.78) removal. The physician group demonstrated a higher rate of grade 3 hematomas (p = 0.03). There was no statistically significant difference between CCP and physician groups for limb complications and mortality. Survey results showed an improved efficiency in bed space allocation, physician workload and a decreased IABP support time. CONCLUSION There is no difference in limb complications between perfusionist and physician removal of IABP catheters. The survey demonstrate an improvement in resource allocation and efficiency. A perfusionist led IABP removal program can be done safely and may help improve program efficiency.
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Affiliation(s)
- Richard Saczkowski
- Interior Health Cardiac Sciences Program, Department of Cardiovascular Perfusion, Kelowna General Hospital, Kelowna, BC, Canada
| | - Saverio Spada
- Interior Health Cardiac Sciences Program, Department of Cardiovascular Perfusion, Kelowna General Hospital, Kelowna, BC, Canada
| | - Kris Hromadnik
- Department of Cardiovascular Perfusion, Queen Elizabeth II Hospital, Halifax, NS, Canada
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Heuts S, Lorusso R, di Mauro M, Jiritano F, Scrofani R, Antona C, Dato GA, Centofanti P, Ferrarese S, Matteucci M, Miceli A, Glauber M, Vizzardi E, Sponga S, Vendramin I, Garatti A, de Vincentiis C, De Bonis M, Pieri M, Troise G, Tomba MD, Serraino GF. Sheathless Versus Sheathed Intra-Aortic Balloon Pump Implantation in Patients Undergoing Cardiac Surgery. Am J Cardiol 2023; 189:86-92. [PMID: 36516701 DOI: 10.1016/j.amjcard.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/20/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
The intra-aortic balloon pump (IABP) is the most widely available mechanical support device, but its use has been disputed in recent decades. Although several efforts have been made to reduce the associated complication rate, contemporary data on this matter is lacking. The present study aims to evaluate the differences in vascular complications between the sheathless and the sheathed IABP implantation technique in cardiac surgery patients. A retrospective multi-center cohort, consisting of patients treated in 8 cardiac surgical centers, was evaluated. Patients who underwent cardiac surgery with peri-operative IABP support were included. Primary outcome was a composite end point of vascular complications. Propensity score matching (PSM) was performed, and a multivariable regression model was applied to evaluate predictors of vascular complications. The unmatched cohort consisted of 2,615 patients (sheathless n = 1,414, 54%, sheathed n = 1,201, 46%). A total of 878 patients were matched (n = 439 for both groups). The composite vascular complication end point occurred in 3% of patients in the sheathless group, compared with 8% in the sheathed group (p <0.001). Vascular complications were significantly associated with mortality (odds ratio [OR] 3.86, 95% confidence interval [CI] 2.01 to 7.40, p <0.001). Peripheral arterial disease was associated with vascular complications (OR 3.10, 95% CI 1.46 to 6.55, p = 0.003), whereas the sheathless implantation technique was found to be protective (OR 0.36, 95% CI 0.18 to 0.73, p = 0.005). In conclusion, the present retrospective multi-center analysis demonstrated the sheathless implantation technique to be associated with a significant reduction in vascular complication rate. Future studies should focus on even less invasive implantation techniques using smaller-sized catheters, sheathless implantation, and imaging guiding.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands; Cardiac Surgery Unit, A.O. Spedali Civili, Brescia, Italy.
| | - Michele di Mauro
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Federica Jiritano
- Cardiac Surgery Department, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | | | - Carlo Antona
- Cardiac Surgery Department, Ospedale Sacco, Milan, Italy
| | | | - Paolo Centofanti
- Department of Cardiovascular Surgery, Ospedale Mauriziano, Torino, Italy
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | | | - Sandro Sponga
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, Ospedale di S. Donato, Milan, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Ospedale S. Raffaele, Milan, Italy
| | - Marina Pieri
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Troise
- Department of Cardiac Surgery, Ospedale Poliambulanza, Brescia, Italy
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Ortoleva J. Intra-aortic balloon pump as a vent in VA-ECMO; lower risk, but beware. J Cardiothorac Vasc Anesth 2022; 36:4553. [PMID: 36057508 DOI: 10.1053/j.jvca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jamel Ortoleva
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States.
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González LS, Grady M. Intra-aortic balloon pump counterpulsation: technical function, management, and clinical indications. Int Anesthesiol Clin 2022; 60:16-23. [PMID: 35975922 DOI: 10.1097/aia.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Lorusso R, Heuts S, Jiritano F, Scrofani R, Antona C, Actis Dato G, Centofanti P, Ferrarese S, Matteucci M, Miceli A, Glauber M, Vizzardi E, Sponga S, Vendramin I, Garatti A, de Vincentis C, De Bonis M, Ajello S, Troise G, Dalla Tomba M, Serraino F. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6563853. [PMID: 35381083 PMCID: PMC9252119 DOI: 10.1093/icvts/ivac091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiac Surgery, A.O. Spedali Civili, Brescia, Italy
- Corresponding author. Department of Cardiothoracic Surgery, Maastricht University Medical Center+, 6229 HX, Maastricht, Netherlands. Tel: +31-43-387-50-70; e-mail: (R. Lorusso)
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Federica Jiritano
- Department of Cardiac Surgery, Ospedale Universitario, Catanzaro, Italy
| | | | - Carlo Antona
- Department of Cardiac Surgery, Ospedale Sacco, Milan, Italy
| | | | - Paolo Centofanti
- Department of Cardiac Surgery, Ospedale Mauriziano, Torino, Italy
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Enrico Vizzardi
- Department of Cardiac Surgery, A.O. Spedali Civili, Brescia, Italy
| | - Sandro Sponga
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, Ospedale di S. Donato, Milan, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Ospedale S. Raffaele, Milan, Italy
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Troise
- Department of Cardiac Surgery, Ospedale Poliambulanza, Brescia, Italy
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Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Jeevanandam V, Milner R, Ota T. Significant vascular complications in percutaneous axillary intra-aortic balloon pump. Ann Vasc Surg 2022; 83:42-52. [DOI: 10.1016/j.avsg.2021.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
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Baldetti L, Pagnesi M, Gramegna M, Belletti A, Beneduce A, Pazzanese V, Calvo F, Sacchi S, Van Mieghem NM, den Uil CA, Metra M, Cappelletti AM. Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice. Circ Heart Fail 2021; 14:e008527. [PMID: 34706550 DOI: 10.1161/circheartfailure.121.008527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure-related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.
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Affiliation(s)
- Luca Baldetti
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Matteo Pagnesi
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
| | - Mario Gramegna
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Alessandro Belletti
- Cardiac Intensive Care Unit, Department of Anesthesia and Intensive Care (A. Belletti)
| | | | - Vittorio Pazzanese
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Francesco Calvo
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Stefania Sacchi
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Nicolas M Van Mieghem
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.)
| | - Corstiaan A den Uil
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.).,Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands (C.A.d.U.)
| | - Marco Metra
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
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Daubenspeck D, González LS, Gerlach RM, Chaney MA. Unique Complications Associated With the Subclavian Intra-Aortic Balloon Pump. J Cardiothorac Vasc Anesth 2020; 35:2212-2222. [PMID: 33485757 DOI: 10.1053/j.jvca.2020.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Rebecca M Gerlach
- Department of Anesthesiology and Critical Care, Preoperative Anesthesia Clinic, University of New Mexico, Albuquerque, NM; Preoperative Anesthesia Clinic, University of New Mexico, Albuquerque, NM
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes. Anesth Analg 2020; 131:776-791. [DOI: 10.1213/ane.0000000000004954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rodriguez Lima DR, Duran EJ, Rojas Díaz EL, Pinilla Rojas DI, Mercado Díaz MA, Bustos Martínez YF. Ultrasound-guided insertion of intra-aortic balloon counterpulsation in intensive care: description of the technique. Ultrasound J 2020; 12:23. [PMID: 32318835 PMCID: PMC7174474 DOI: 10.1186/s13089-020-00166-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
Intra-aortic balloon counterpulsation (IAoBC) is a mechanical circulatory support device that has been used for more than 50 years, mainly for cardiogenic shock. Although its effect on mortality is controversial, IAoBC is still used in a wide variety of pre- and postoperative clinical settings in cardiac surgery centers. IAoBC has a complication rate of approximately 30%, mostly associated with problems during insertion and malpositioning. Thus, an insertion technique based on the use of ultrasound at the patient's bedside in the intensive care unit (ICU) is proposed.
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Affiliation(s)
- David Rene Rodriguez Lima
- Emergency Medicine and Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad Del Rosario, Bogotá, Colombia.
| | - Ever Julián Duran
- Resident, Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi -Universidad del Rosario, Bogotá, Colombia
| | - Ever Leonardo Rojas Díaz
- Resident, Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi -Universidad del Rosario, Bogotá, Colombia
| | - Darío Isaías Pinilla Rojas
- Anesthesiology and Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
| | - Mario Andrés Mercado Díaz
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 1877] [Impact Index Per Article: 375.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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13
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Gharaie SH, Amir Moghadam AA, Al'Aref SJ, Caprio A, Alaie S, Zgaren M, Min JK, Dunham S, Mosadegh B. A Proof-of-Concept Demonstration for a Novel Soft Ventricular Assist Device. J Med Device 2019. [DOI: 10.1115/1.4043052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients treated by current ventricular assist devices (VADs) suffer from various post implantation complications including gastrointestinal bleeding and arteriovenous malformation. These issues are related to intrinsically mismatch of generated flow by VADs and the physiological flow. In addition, the common primary drawback of available VADs is excessive surgical dissection during implantation, which limits these devices to less morbid patients. We investigated an alternative soft VAD (SVAD) system that generates physiological flow, and designed to be implanted using minimally invasive surgery by leveraging soft materials. A soft VAD (which is an application of intraventricular balloon pump) is developed by utilizing a polyurethane balloon, which generates pulsatile flow by displacing volume within the left ventricle during its inflation and deflation phases. Our results show that the SVAD system generates an average ejection fraction of 50.18 ± 1.52% (n = 6 ± SD) in explanted porcine hearts. Since the SVAD is implanted via the apex of the heart, only a minithoracotomy should be required for implantation. Our results suggest that the SVAD system has the performance characteristics that could potentially make it useful for patients in acute and/or chronic heart failure, thus serving as a bridge-to-transplantation or bridge-to-recovery.
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Affiliation(s)
- Saleh H. Gharaie
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Amir Ali Amir Moghadam
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Subhi J. Al'Aref
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Alexandre Caprio
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Seyedhamidreza Alaie
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Mohamed Zgaren
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - James K. Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Simon Dunham
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 413 E.69th street, Suite 108, New York, NY 10021 e-mail:
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Samalavicius R, Puodziukaite L, Radaviciute I, Norkiene I, Urbonas K, Misiuriene I, Janusauskas V, Zorinas A, Rucinskas K, Serpytis P. Prophylactic use of an intra-aortic balloon pump in a high-risk patient with peripartum cardiomyopathy requiring cesarean delivery. Int J Obstet Anesth 2018; 33:67-71. [DOI: 10.1016/j.ijoa.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022]
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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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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 645] [Impact Index Per Article: 92.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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de Jong MM, Lorusso R, Al Awami F, Matteuci F, Parise O, Lozekoot P, Bonacchi M, Maessen JG, Johnson DM, Gelsomino S. Vascular complications following intra-aortic balloon pump implantation: an updated review. Perfusion 2017; 33:96-104. [PMID: 28816093 PMCID: PMC5844455 DOI: 10.1177/0267659117727825] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using this device. One of the reasons for this could be the increase in vascular complications when using the pump. Therefore, the aim of the present review was to assess the current literature available with regards to IABP vascular complications during the clinical situation. Methods: A literature search was performed, searching for IABP complications in adult human studies between 1990 and 2016. Results: A total of 20 reports were identified as fitting the criteria of this study. The majority of vascular complications were limb ischemia, bleeding or mesenteric ischemia. The overall incidence of vascular complications ranged from 0.94% to 31.1%. Diabetes, peripheral vascular disease and hypertension, as well as smoking were all identified as risk factors for complications following IABP. Furthermore, studies supported the use of sheathless balloon insertion to reduce the risk of complications. Conclusion: Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP. However, the incidence of these complications was generally low. Further studies are still required to truly understand the risk/benefit associated with the use of IABP.
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Affiliation(s)
- Monique M de Jong
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Roberto Lorusso
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Fatima Al Awami
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Francesco Matteuci
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Orlando Parise
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Pieter Lozekoot
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Massimo Bonacchi
- 2 Section of Cardiac Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jos G Maessen
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Daniel M Johnson
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
| | - Sandro Gelsomino
- 1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, The Netherlands
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Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC. IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg 2016; 11:122. [PMID: 27487772 PMCID: PMC4972967 DOI: 10.1186/s13019-016-0513-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/27/2016] [Indexed: 11/18/2022] Open
Abstract
Treatment with the intraaortic balloon pump (IABP) is the most common form of mechanical support for the failing heart. Augmentation of diastolic pressure during balloon inflation contributes to the coronary circulation and the presystolic deflation of the balloon reduces the resistance to systolic output. Consequently, the myocardial work is reduced. The overall effect of the IABP therapy is an increase in the myocardial oxygen supply/demand ratio and thus in endocardial viability. This is an overall synopsis of what we need to know regarding IABP. Furthermore, this review article attempts to systematically delineate the pathophysiology linked with the hemodynamic consequences of IABP therapy. The authors also look at the future of the use of the balloon pump and conclude that the positive multi-systemic hemodynamic regulation during IABP treatment should further justify its use.
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Affiliation(s)
- H Parissis
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - V Graham
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland.
| | - S Lampridis
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - M Lau
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - G Hooks
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - P C Mhandu
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
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Spratt JR, Raveendran G, Liao K, John R. Novel percutaneous mechanical circulatory support devices and their expanding applications. Expert Rev Cardiovasc Ther 2016; 14:1133-50. [DOI: 10.1080/14779072.2016.1214573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Complete atrioventricular block improved by balloon aortic valvuloplasty for severe aortic stenosis: Usefulness of sheathless technique in the retrograde approach. J Cardiol Cases 2016; 13:181-184. [DOI: 10.1016/j.jccase.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/12/2016] [Accepted: 02/05/2016] [Indexed: 11/20/2022] Open
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Serum Brain Natriuretic Peptide Concentration 60 Days After Surgery as a Predictor of Long-Term Prognosis in Patients Implanted With a Left Ventricular Assist Device. ASAIO J 2016; 61:e36-9. [PMID: 26120957 PMCID: PMC4487874 DOI: 10.1097/mat.0000000000000237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mechanical circulatory support by a left ventricular assist device (LVAD) is used to bridge patients with advanced heart failure to transplant or as a definitive treatment. We retrospectively sought predictors of long-term outcome in a cohort of 83 patients who had undergone LVAD treatment. We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival. Mean follow-up was 717 days (standard deviation, 334 days; range, 17-1,592 days). Fourteen patients (16.8%) died, but nine (10.8%) were weaned from support. Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality. The optimal BNP cutoff value to predict death during LVAD support was 322 pg/ml, with a sensitivity of 71.4% and specificity of 79.8%. Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003). The relation between BNP and survival likely reflects recovery of native myocardial function and improvements in global health and should assist clinicians in the on-going management of long-term LVAD therapy.
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Kapur NK, Esposito M. Hemodynamic Support with Percutaneous Devices in Patients with Heart Failure. Heart Fail Clin 2015; 11:215-30. [DOI: 10.1016/j.hfc.2014.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, Thiele H, Werdan K, Zeymer U, Prondzinsky R. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev 2015; 2015:CD007398. [PMID: 25812932 PMCID: PMC8454261 DOI: 10.1002/14651858.cd007398.pub3] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intra-aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction. Although there has been only limited evidence from randomised controlled trials, the previous guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) strongly recommended the use of the IABP in patients with infarction-related cardiogenic shock on the basis of pathophysiological considerations, non-randomised trials and registry data. The recent guidelines downgraded the recommendation based on a meta-analysis which could only include non-randomised trials showing conflicting results. Up to now, there have been no guideline recommendations and no actual meta-analysis including the results of the large randomised multicentre IABP-SHOCK II Trial which showed no survival benefit with IABP support. This systematic review is an update of the review published in 2011. OBJECTIVES To evaluate, in terms of efficacy and safety, the effect of IABP versus non-IABP or other assist devices guideline compliant standard therapy on mortality and morbidity in patients with acute myocardial infarction complicated by cardiogenic shock. SEARCH METHODS Searches of CENTRAL, MEDLINE (Ovid) and EMBASE (Ovid), LILACS, IndMed and KoreaMed, registers of ongoing trials and proceedings of conferences were updated in October 2013. Reference lists were scanned and experts in the field contacted to obtain further information. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials on patients with acute myocardial infarction complicated by cardiogenic shock. DATA COLLECTION AND ANALYSIS Data collection and analysis were performed according to the published protocol. Individual patient data were provided for six trials and merged with aggregate data. Summary statistics for the primary endpoints were hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs). MAIN RESULTS Seven eligible studies were identified from a total of 2314 references. One new study with 600 patients was added to the original review. Four trials compared IABP to standard treatment and three to other percutaneous left assist devices (LVAD). Data from a total of 790 patients with acute myocardial infarction and cardiogenic shock were included in the updated meta-analysis: 406 patients were treated with IABP and 384 patients served as controls; 339 patients were treated without assisting devices and 45 patients with other LVAD. The HR for all-cause 30-day mortality of 0.95 (95% CI 0.76 to 1.19) provided no evidence for a survival benefit. Different non-fatal cardiovascular events were reported in five trials. During hospitalisation, 11 and 4 out of 364 patients from the intervention groups suffered from reinfarction or stroke, respectively. Altogether 5 out of 363 patients from the control group suffered from reinfarction or stroke. Reocclusion was treated with subsequent re-revascularization in 6 out of 352 patients from the intervention group and 13 out of 353 patients of the control group. The high incidence of complications such as moderate and severe bleeding or infection in the control groups has to be attributed to interventions with other LVAD. Possible reasons for bias were more frequent in small studies with high cross-over rates, early stopping and the inclusion of patients with IABP at randomisation. AUTHORS' CONCLUSIONS Available evidence suggests that IABP may have a beneficial effect on some haemodynamic parameters. However, this did not result in survival benefits so there is no convincing randomised data to support the use of IABP in infarct-related cardiogenic shock.
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Affiliation(s)
- Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Magdeburge Straße 8, Halle/Saale, Germany, 06097
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25
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White JM, Ruygrok PN. Intra-aortic balloon counterpulsation in contemporary practice - where are we? Heart Lung Circ 2014; 24:335-41. [PMID: 25616681 DOI: 10.1016/j.hlc.2014.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/18/2022]
Abstract
The intra-aortic balloon pump (IABP) remains the most widely used form of mechanical circulatory support in current clinical practice. This article will review the current evidence to guide IABP use, focussing on large registry and prospective, randomised data, and seek to establish appropriate roles for the IABP in contemporary practice. Despite a paucity of clinical evidence, the IABP remains a useful clinical tool in selected settings, although its routine, up-front use in relatively unselected MI populations is not supported by data. Although current evidence no longer supports routine use in certain high-risk groups, further studies of appropriately selected high-risk patients may yet demonstrate benefit in patients with moderate-severe degrees of shock.
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Affiliation(s)
- Jonathon M White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Peter N Ruygrok
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; University of Auckland School of Medicine, Auckland, New Zealand.
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26
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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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27
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Corazza I, Bianchini D, Marcelli E, Cercenelli L, Zannoli R. Passive aortic counterpulsation: Biomechanical rationale and bench validation. J Biomech 2014; 47:1618-25. [DOI: 10.1016/j.jbiomech.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/08/2014] [Accepted: 03/01/2014] [Indexed: 11/26/2022]
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28
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Vascular complications and special problems in vascular trauma. Eur J Trauma Emerg Surg 2013; 39:569-89. [DOI: 10.1007/s00068-013-0336-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 12/17/2022]
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29
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Hajj-Chahine J, Jayle C, Houmaida H, Corbi P. eComment. Sheathless intra-aortic balloon pump insertion. Interact Cardiovasc Thorac Surg 2012; 15:139-40. [PMID: 22723544 DOI: 10.1093/icvts/ivs196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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30
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Valente S, Lazzeri C, Crudeli E, Chiostri M, Giglioli C, Bernardo P, Gensini GF. Intraaortic balloon pump: incidence and predictors of complications in the Florence registry. Clin Cardiol 2011; 35:200-4. [PMID: 22147681 DOI: 10.1002/clc.20975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/13/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The intraaortic balloon pump (IABP) is the most commonly used mechanical circulatory support for patients with acute coronary syndromes and cardiogenic shock. Nevertheless, IABP-related complications are still frequent and associated with a poor prognosis. HYPOTHESIS To prospectively assess the incidence and predictors of complications in patients treated with IABP. METHODS A total of 481 patients treated with IABP were prospectively enrolled in our registry (the Florence Registry). At multivariable logistic regression analysis the following variables were independent predictors for complications (when adjusted for age >75 years, eGFR and time length of IABP support): use of inotropes (OR 2.450, P < 0.017), nadir platelet count (1000/µL step; OR 0.990, P < 0.001), admission lactate (OR 1.175, P = 0.003). Nadir platelet count showed a negative correlation with length of time of IABP implantation (r-0.31; P < 0.001). A nadir platelet count cutoff value of less than 120,000 was identified using a receiver operating characteristic (ROC) curve for the development of complications (area under the curve [AUC] 0.70; P < 0.001). RESULTS Complications were observed in the 13.1%, among whom 33 of 63 showed major bleeding. The incidence of complications was higher in patients aged >75 years (P = 0.015) and in those who had an IABP implanted for more than 24 hours (P = 0.001). Patients with complications showed an in Intensive Cardiac Care Unit (ICCU) mortality higher than patients who did not (44.4% vs 17.2%, P < 0.001). CONCLUSIONS In consecutive patients treated with IABP support, the degree of hemodynamic impairment and the decrease in platelet count were independent predictors of complications, whose development was associated with higher in-ICCU mortality.
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Affiliation(s)
- Serafina Valente
- Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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31
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Parissis H, Soo A, Al-Alao B. Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg 2011; 6:147. [PMID: 22047038 PMCID: PMC3216865 DOI: 10.1186/1749-8090-6-147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 11/02/2011] [Indexed: 11/10/2022] Open
Abstract
The increasing use of the intra aortic balloon pump is attributed to the relatively easy percutaneous insertion and the low threshold of use over the past few years, especially in elderly patients with multi-vessel diseases and an affected ejection fraction.Unfortunately, the clinical assessment of the complications associated to the use of this supporting device, underestimates the frequency of such complications.This report has looked at the current literature and attempt to identify incremental risk factors related to the development of adverse effects during support with an intaaortic balloon pump.The paper concludes that in contrary to early reports, newer studies have shown that complications following intraaortic balloon pump treatment, is decreasing. Moreover the literature suggests that the thrombosis and infective complications are relevant to the duration of the pump treatment, while the ischemic problems of the limbs are mostly linked to the atherosclerotic status of the common femoral artery.
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32
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Unverzagt S, Machemer MT, Solms A, Thiele H, Burkhoff D, Seyfarth M, de Waha A, Ohman EM, Buerke M, Haerting J, Werdan K, Prondzinsky R. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev 2011:CD007398. [PMID: 21735410 DOI: 10.1002/14651858.cd007398.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intra-aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction.Although there is only limited evidence by randomised controlled trials, the current guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology strongly recommend the use of the intra-aortic balloon counterpulsation in patients with infarction-related cardiogenic shock on the basis of pathophysiological considerations as also non-randomised trials and registry data. OBJECTIVES To determine the effect of IABP versus non-IABP or other assist devices guideline compliant standard therapy, in terms of efficacy and safety, on mortality and morbidity in patients with acute myocardial infarction complicated by cardiogenic shock. SEARCH STRATEGY Searches of CENTRAL, MEDLINE and EMBASE, LILACS, IndMed and KoreaMed, registers of ongoing trials and proceedings of conferences were conducted in January 2010, unrestricted by date. Reference lists were scanned and experts in the field contacted to obtain further information. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials on patients with myocardial infarction complicated by cardiogenic shock. DATA COLLECTION AND ANALYSIS Data collection and analysis were performed according to a published protocol. Individual patient data were provided for five trials and merged with aggregate data. Summary statistics for the primary endpoints were hazard ratios (HR's) and odds ratios with 95% confidence intervals (CI). MAIN RESULTS Six eligible and two ongoing studies were identified from a total of 1410 references. Three compared IABP to standard treatment and three to percutaneous left assist devices (LVAD). Data from a total of 190 patients with acute myocardial infarction and cardiogenic shock were included in the meta-analysis: 105 patients were treated with IABP and 85 patients served as controls. 40 patients were treated without assisting devices and 45 patients with LVAD. HR's for all-cause 30-day mortality of 1.04 (95% CI 0.62 to 1.73) provides no evidence for a survival benefit. While differences in survival were comparable in patients treated with IABP, with and without LVAD, haemodynamics and incidences of device related complications show heterogeneous results. AUTHORS' CONCLUSIONS Available evidence suggests that IABP may have a beneficial effect on the haemodynamics, however there is no convincing randomised data to support the use of IABP in infarct related cardiogenic shock.
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Affiliation(s)
- Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburge Straße 8, Halle/Saale, Germany, 06097
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Stabile E, Sorropago G, Tesorio T, Popusoi G, Ambrosini V, Mottola MT, Biamino G, Rubino P. Heparin versus bivalirudin for carotid artery stenting using proximal endovascular clamping for neuroprotection: Results from a prospective randomized study. J Vasc Surg 2010; 52:1505-10. [DOI: 10.1016/j.jvs.2010.06.098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/16/2010] [Accepted: 06/05/2010] [Indexed: 11/29/2022]
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34
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Stabile E, Salemme L, Sorropago G, Tesorio T, Nammas W, Miranda M, Popusoi G, Cioppa A, Ambrosini V, Cota L, Petroni G, Della Pietra G, Ausania A, Fontanelli A, Biamino G, Rubino P. Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1,300 patients. J Am Coll Cardiol 2010; 55:1661-7. [PMID: 20394868 DOI: 10.1016/j.jacc.2009.11.079] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 11/02/2009] [Accepted: 11/02/2009] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This single-center registry presents the results of proximal endovascular occlusion (PEO) use in an unselected patient population. BACKGROUND In published multicenter registries, the use of PEO for carotid artery stenting (CAS) has been demonstrated to be safe and efficient in patient populations selected for anatomical and/or clinical conditions. METHODS From July 2004 to May 2009, 1,300 patients underwent CAS using PEO. Patients received an independent neurological assessment before the procedure and 1 h, 24 h, and 30 days after the procedure. RESULTS Procedural success was achieved in 99.7% of patients. In hospital, major adverse cardiac or cerebrovascular events included 5 deaths (0.38%), 6 major strokes (0.46%), 5 minor strokes (0.38%), and no acute myocardial infarction. At 30 days of follow-up, 2 additional patients died (0.15%), and 1 patient had a minor stroke (0.07%). The 30-day stroke and death incidence was 1.38% (n = 19). Symptomatic patients presented a higher 30-day stroke and death incidence when compared with asymptomatic patients (3.04% vs. 0.82%; p < 0.05). No significant difference in 30-day stroke and death rate was observed between patients at high (1.88%; n = 12) and average surgical risk (1.07; n = 7) (p = NS). Operator experience, symptomatic status, and hypertension were found to be independent predictors of adverse events. CONCLUSIONS The use of PEO for CAS is safe and effective in an unselected patient population. Anatomical and/or clinical conditions of high surgical risk were not associated with an increased rate of adverse events.
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Affiliation(s)
- Eugenio Stabile
- Invasive Cardiology Laboratory, Cardiology Division, Clinica Montevergine, Via Mario Malzoni 1, Mercogliano, Italy.
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Lewis PA, Ward DA, Courtney MD. The intra-aortic balloon pump in heart failure management: implications for nursing practice. Aust Crit Care 2009; 22:125-31. [PMID: 19628405 DOI: 10.1016/j.aucc.2009.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022] Open
Abstract
Management of acute heart failure is an important consideration in critical care. Mechanical support of the failing heart is crucial for improving health outcomes. The most common Australasian application of intra-aortic balloon counterpulsation (IABP) is in the setting of cardiogenic shock. High end users of IABP (>37/annum) demonstrate significantly lower mortality for cardiogenic shock managed with IABP (p<0.001) in contrast to hospitals which employ limited IABP (<4/annum). This underscores the importance of proficiency in managing the patient receiving IABP support. Nurses play a crucial role in caring for patients with acute heart failure. This paper summarises care considerations for management of the IABP.
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Affiliation(s)
- Peter A Lewis
- Queensland University of Technology, Brisbane, Queensland, Australia.
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36
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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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Kocogullari CU, Emmiler M, Ayva E, Cekirdekct A. IABP-Related vascular complications: who is responsible--the patient, the surgeon or the sheath? Part I: sheath-related complications. Adv Ther 2008; 25:225-30. [PMID: 18345522 DOI: 10.1007/s12325-008-0027-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION An intra-aortic balloon pump (IABP) is frequently used as a mechanical support during the treatment of low cardiac output syndrome. The use of a sheath during IABP treatment can be associated with ischaemic complications in the extremities. The aim of our study was to determine the isolated role of sheaths in the development of vascular complications following IABP catheterisation. METHODS We evaluated a total of 81 patients who had received an IABP for haemodynamic stability, between January 2003 and October 2007, following cardiovascular surgery. To eliminate surgical-related variables, only patients with IABPs and size 8.5 or 9 French catheters (inserted by experienced cardiovascular surgeons using the percutaneous Seldinger technique) were included in the study. To eliminate patient-related variables, patients with a known risk factor for either thrombosis, embolus or peripheral arterial disease were excluded from the study. RESULTS The patients were divided into two groups: Group 1 (sheathed catheter group; n=42), Group 2 (sheathless catheter group; n=39). Ischaemic complications were observed in a total of five patients. Four of these patients were from Group 1 and one was from Group 2. CONCLUSION Sheathed catheterisation was found to increase the risk of vascular complications in patients who underwent IABP application. Therefore sheathless catheterisation is recommended for IABP application.
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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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Abstracts of the 5th International Meeting on Intensive Cardiac Care, October 14-16, 2007, Tel Aviv, Israel. ACTA ACUST UNITED AC 2007; 9:134-74. [PMID: 17917844 DOI: 10.1080/17482940701649731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Turi ZG. An early exit strategy for intra-aortic balloon counterpulsation. Catheter Cardiovasc Interv 2007; 70:541-2. [PMID: 17896400 DOI: 10.1002/ccd.21347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Klein AJ, Messenger JC, Casserly IP. Endovascular treatment of intra-aortic balloon pump-induced acute limb ischemia. Catheter Cardiovasc Interv 2007; 70:138-42. [PMID: 17585391 DOI: 10.1002/ccd.21177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The development of acute limb ischemia in patients following intra-aortic balloon pump (IABP) placement remains a frequent event that presents a significant management challenge. We report two recent cases of this clinical event from our institution, which demonstrate that endovascular therapies may be used to treat acute limb ischemia in this setting without requiring removal of the IABP.
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Affiliation(s)
- Andrew J Klein
- University of Colorado Health Sciences at Denver, Division of Cardiology, Denver, Colorado, USA
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