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At least 919 records · Page 51Linked to original sources
PubMed1986

Use of the intra-aortic balloon pump after valve replacement. Predictive indices, correlative parameters, and patient survival.

Intra-aortic balloon pump counterpulsation required as an adjunct during weaning from cardiopulmonary bypass or for circulatory support in the immediate postoperative period was analyzed in 2,498 patients undergoing valve replacement between December, 1972, and September, 1981. A total of 140 successful insertions were performed in 155 attempts. Ninety-five of these patients were from a homogeneous cohort of 1,908 patients undergoing valve replacement with porcine xenografts and were analyzed for factors that might be useful predictors of the need for balloon pump support. Univariate analysis of individual factors delineated preoperative characteristics in patients having mitral valve replacement and intraoperative factors in all patients that correlated with use of the balloon pump. Multivariate analysis revealed a subset of male patients with mitral valve and coronary disease most likely to require counterpulsation. Overall survival rate was markedly reduced at 30 days (balloon counterpulsation plus valve replacement, 50% +/- 5%; valve replacement only, 96% +/- 5%; p less than 0.001) and at 1 year (balloon counterpulsation plus valve replacement, 38% +/- 5%; valve replacement only, 89% +/- 1%, p less than 0.001) if balloon pumping was required. The entire group of 140 patients were retrospectively analyzed for factors predictive of survival. Patients requiring balloon pumping who had a preoperative diagnosis of aortic regurgitation had a lower 1 year survival rate (13% +/- 9%) than the total subgroup undergoing balloon counterpulsation (36% +/- 4.0%) (p = 0.002). Similarly patients treated by balloon counterpulsation who had postoperative renal failure had a significantly lower 1 year survival rate (17% +/- 5%) than those without renal failure (66% +/- 6%) (p = 0.003). The survival rate of patients who required this therapeutic modality after valve replacement is poor. Other methods of hemodynamic support are necessary.

Aortic Valve↗
PubMed2002

[Testing of the latissimus dorsi muscle stimulation regimens in the experimental model of thoracic aortomyoplasty].

OBJECTIVE: Among several alternative forms of treatment for congestive heart failure patients is the use of autologous muscle-powered cardiac assistance. Our investigation was aimed to study two different regimens of latissimus dorsi muscle electrostimulation in acute thoracic aortomyoplasty. MATERIAL AND METHODS: Experiments were made in Kaunas University of Medicine and Wisconsin University, Milwaukee Heart institute. In two experimental groups (of 6 dogs each), aortomyoplasty was performed, using a new cardiomyostimulator LD-PACE II. The latissimus dorsi muscle was subject to one of the following stimulation regimens: continuous electrostimulation or work-rest electrostimulation (one minute work - one minute rest). RESULTS: In group 1 (continuous electrostimulation regimen) thoracic aortic counterpulsation resulted in significantly improved hemodynamic parameters. However, after 60 minutes, hemodynamic values decreased to pre-assist levels. In group 2 (work-rest regimen) thoracic aortic counterpulsation resulted in significantly improved hemodynamic parameters during the first 20 minutes of testing but all values were worse than with the I group regimen. All values within the next 20 minutes were better than those obtained in I group, although not statistically significant. However, for a total of 60 minutes of counterpulsation, the differences between group 1 and group 2 did become statistically significant. In group 2 we continued counterpulsation for 100 minutes before values returned to baseline. CONCLUSIONS: According to our study extraaortic counterpulsation using cardiomyostimulator LD-PACE II shows an improvement of hemodynamic parameters during assisted cardiac cycles; a new work-rest electrostimulation regimen is useful for saving latissimus dorsi muscle from damage of electrical stimulation.

Animal Experimentation↗
PubMed1999

[Reperfusion therapy and mechanical circulatory support in patients in cardiogenic shock].

Cardiogenic shock is a state of inadequate tissue perfusion due to cardiac dysfunction, which is most commonly caused by acute myocardial infarction. The pathophysiology of cardiogenic shock is characterized by a downward spiral: ischemia causes myocardial dysfunction, which, in turn, augments the ischemic damage and the energetical imbalance. With conservative therapy, mortality rates for patients with cardiogenic shock are frustratingly high reaching more than 80%. Additional thrombolytic therapy has not been shown to significantly improve survival in such patients. Emergency cardiac catheterization and coronary angioplasty, however, seem to improve the outcome in shock-patients, which most probably is due to rapid and complete revascularization generally reached by angioplasty. In addition to interventional therapy with rapid coronary revascularization, the use of mechanical circulatory support may interrupt the vicious cycle in cardiogenic shock by stabilizing hemodynamics and the metabolic situation. Different cardiac assist devices are available for cardiologists and cardiac surgeons: 1. intraaortic balloon counterpulsation (IABP), 2. implantable turbine-pump (Hemopump), 3. percutaneous cardiopulmonary bypass support (CPS), 4. right heart, left heart, or biventricular assist devices placed by thoracotomy, and 5. intra- and extrathoracic total artificial hearts. Since percutaneous application is possible with IABP, Hemopump and CPS, these devices are currently used in interventional cardiology. The basic goals of the less invasive intraaortic balloon counterpulsation (IABP; Figure 1) are to stabilize circulatory collapse, to increase coronary perfusion and myocardial oxygen supply, and to decrease left ventricular workload and myocardial oxygen demand (Figure 2). Since the advent of percutaneous placement, IABP has been used by an increasing number of institutions (Figure 3). In addition to cardiogenic shock, the system may be of use in a variety of other indications in the catheterization laboratory and intensive care unit, including weaning from percutaneous cardiopulmonary bypass, in ischaemic left ventricular failure, in unstable angina, in high risk PTCA, and in prophylactic support in patients with myocardial infarction and successful revascularization. Animal experimental data showed that IABP may improve success of thrombolysis and recent clinical data suggest that survival is enhanced and transfer for revascularization is facilitated when patients with myocardial infarction and cardiogenic shock undergo thrombolysis and IABP rather than thrombolysis alone. A lot of studies had demonstrated before, that combined use of counterpulsation and revascularization therapy (i.e. coronary bypass surgery or angioplasty) may improve prognosis in patients with myocardial infarction complicated by cardiogenic shock (Table 1). In such patients, early treatment with IABP is most important: Multivariate analysis identified early IABP-support with a duration of shock to IABP-treatment of > or = 4 hours as an independent predictor of a positive short-term outcome. In shock-patients with postinfarction ventricular septal defect, IABP provides a marked hemodynamic improvement, and a significant decrease in shunt-flow (Figure 5). However, despite initial stabilization with IABP, such patients need immediate surgical repair of the septal defect to avoid hemodynamic deterioration. The rate of complications related to percutaneous IABP was significantly attenuated by employing catheters of reduced size. Using 9.5-F catheters, a long duration of counterpulsation emerged as the most significant factor associated with complications. In our hospital, those patients with 9.5-F catheters in whom counterpulsation did not exceed 48 hours had a low complication rate of 3.9%. The Hemopump is a catheter-mounted transvalvular left ventricular assist device intended for surgical placement via the femoral artery (Figures 6 and 7). (ABSTRACT TRUNCATED)

Cardiopulmonary Bypass↗
PubMed1987

Circulatory support for right ventricular dysfunction.

New modes of circulatory support for right ventricular dysfunction have recently been described. The present study compared the effectiveness of pulmonary artery balloon counterpulsation with a right ventricular assist device for support of surgically induced right ventricular dysfunction. Right ventricular hypertrophy was created in 16 neonatal lambs by pulmonary artery banding. Right ventricular dysfunction was produced in all animals by performing a right ventriculotomy and maintaining the pulmonary artery band. Four unassisted animals developed severe acute right heart failure and died. Six sheep had pulmonary artery balloon counterpulsation with a Dacron graft anastomosed to the proximal pulmonary artery as a reservoir for a 40 ml intra-aortic balloon after the onset of heart failure. The remaining six sheep had a pneumatically activated ventricular assist device inserted between the proximal pulmonary artery and the right ventricular apex. Periods of circulatory support with the balloon pump and the assist device on and off were compared. Decreases in right atrial pressure were observed with both balloon counterpulsation and right ventricular assistance: 14 +/- 1 to 11 +/- 1 mm Hg, p less than 0.0001, versus 19 +/- 2 to 12 +/- 2 mm Hg, p less than 0.0002, respectively. Cardiac output increased with both balloon counterpulsation and ventricular assistance: 1.45 +/- 0.16 to 2.03 +/- 0.13 L/min, p less than 0.001, versus 0.72 +/- 0.15 to 2.24 +/- 0.23 L/min, p less than 0.0002, respectively. Aortic systolic pressure increased in both support groups: 78 +/- 7 to 99 +/- 6 mm Hg, p less than 0.0004, versus 53 +/- 9 to 85 +/- 9 mm Hg, p less than 0.0001, respectively. Ventricular assistance produced greater changes in the right atrial pressure (39% +/- 6% versus 17% +/- 3%, p less than 0.01), cardiac output (153% +/- 39% versus 54% +/- 11%, p less than 0.05), and aortic systolic pressure (85% +/- 13% versus 39% +/- 9%, p less than 0.01). The insertion of a right ventricular assist device caused a significant increment in right ventricular dysfunction. These data, obtained with the devices in place but not operating, showed significantly increased right atrial and right ventricular end-diastolic pressures and approximately 50% less cardiac output than with the pulmonary artery balloon counterpulsation system. The results demonstrate that both modes of circulatory support were effective in reversing surgically induced right ventricular failure.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2001

Hemodynamic evaluation of descending aortomyoplasty versus intra-aortic balloon pump performed in normal animals: an acute study.

OBJECTIVE: Aortomyoplasty is a surgical procedure that aims to induce hemodynamic benefits similar to those of the intra-aortic-balloon-pump (IABP). The objective of this study was to compare the coronary blood flow augmentation and afterload reduction produced by IABP and descending aortomyoplasty counterpulsation. METHODS: From a series of fifteen mongrel dogs (18-35 kg), eight underwent acute descending aortomyoplasty and seven had IABP application. Left anterior descending (LAD) coronary artery blood flow was measured using a Doppler flow probe. Left ventricular pressure in addition to aortic pressures both proximal and distal to either the aortomyoplasty site or the IABP position were monitored continuously. All experiments were acute and performed in normal hearts. RESULTS: Descending aortomyoplasty induced a 27% increase in the LAD blood flow integral during assisted beats (14.0+/-6 ml/min integral compared to 10.8+/-4 ml/min integral in unassisted beats [P<0.001]). This was comparable to an 18% rise in the LAD blood flow integral during IABP counterpulsation (from 8.6+/-3 ml/min to 10.2+/-4 ml/min [P<0.001]). Conversely, while IABP counterpulsation reduced the left ventricular afterload by 16% (from 102+/-23 mmHg to 86+/-26 mmHg [P<0.001]), descending aortomyoplasty did not result in afterload reduction. CONCLUSIONS: Descending aortomyoplasty produces coronary blood flow augmentation comparable to that achieved by the IABP. This may be important for end-stage ischemic patients. However, afterload reduction achieved by the IABP was not reproduced during descending aortomyoplasty counterpulsation. The surgical technique of descending aortomyoplasty should be modified to attain afterload reduction, thus improving treatment for congestive heart failure patients.

Cardiomyoplasty↗
PubMed1994

Dynamic descending thoracic aortomyoplasty: comparison with intraaortic balloon pump in a model of heart failure.

Descending thoracic aortomyoplasty (DTA) uses the latissimus dorsi muscle to compress the proximal descending thoracic aorta as an autogenous diastolic counterpulsator. We studied the hypothesis that DTA could confer hemodynamic benefits equivalent to those yielded by an intraaortic balloon pump (IABP) in dogs (n = 7) with heart failure. The left latissimus dorsi muscle was wrapped around the proximal thoracic aorta and subsequently electrically conditioned to induce fatigue resistance. Heart failure was produced by rapid ventricular pacing after muscle conditioning. Data were collected under three conditions: (1) after the induction of heart failure; (2) with the 20-mL IABP at 1:1; and (3) with the DTA stimulated at 1:1. Effective diastolic counterpulsation was achieved with both the IABP and the DTA. The mean diastolic aortic pressure increased from 66 +/- 5 mm Hg at baseline to 90 +/- 4 mm Hg with the IABP and to 75 +/- 4 mm Hg with the DTA. The left ventricular peak and end-diastolic pressures decreased with IABP (95 +/- 5 mm Hg versus 88 +/- 4 mm Hg and 16 +/- 4 mm Hg versus 12 +/- 4 mm Hg, respectively; p < 0.05) and with DTA (95 +/- 5 mm Hg versus 87 +/- 4 mm Hg and 16 +/- 4 mm Hg versus 12 +/- 4 mm Hg, respectively; p < 0.05). Counterpulsation with the IABP did not change the end-systolic pressure-volume relationship or the time constant for diastolic relaxation, whereas the DTA increased the end-systolic pressure-volume relationship (3.2 +/- 0.6 mm Hg/mL versus 4.0 +/- 0.7 mm Hg/mL; p < 0.05) and decreased the time constant for diastolic relaxation (49 +/- 5 msec versus 45 +/- 6 msec; p < 0.05). These data show that DTA using conditioned skeletal muscle can provide diastolic counterpulsation in animals with compromised cardiac function.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Aortomyoplasty: hemodynamics and comparison to the intraaortic balloon pump.

BACKGROUND: Aortomyoplasty (AMP), a procedure in which the latissimus dorsi muscle (LDM) is wrapped around the aorta and stimulated during diastole, is a potential method of chronic counterpulsation. Counterpulsation by the intraaortic balloon pump (IABP) is a proven treatment for ischemic coronary syndrome and heart failure but cannot be used chronically. This study examined the long-term potential of a unique AMP configuration and compared its performance to the IABP. MATERIALS AND METHODS: AMP was done using a wringer configuration (AMP-W) in nine dogs. Six and 12 months later, acute hemodynamic augmentation was evaluated by measuring differences in mean diastolic aortic pressure (mDAP), peak left ventricular pressure (pLVP), and the endocardial viability ratio (EVR) between stimulated and unstimulated beats. RESULTS: The diastolic augmentation obtained by AMP-W at 6 months and by AMP-W and IABP at 12 months was statistically significant. Additionally, the enhancements in EVR (16.1 +/- 4.3%), mDAP (8.6 +/- 2.5%), and pLVP (-1.8 +/- 1.0%) at 6 months were similar to those in EVR (19.1 +/- 5.2%), mDAP (13.1 +/- 3.6%), and pLVP (-0.8 +/- 1.3%) at 12 months. Most importantly, the augmentation obtained by AMP-W at 12 months was similar to that of the IABP: EVR (17.1 +/- 5.9%), mDAP (13.4 +/- 6.7%), and pLVP (-1.5 +/- 0.8%). CONCLUSIONS: AMP-W is a safe, robust procedure, capable of providing counterpulsation equivalent to the IABP, 12 months following surgery. The potential for AMP-W to offer chronic counterpulsation and to benefit the ischemic heart should be investigated further.

Animals↗
PubMed1976

Effects of metabolic and pharmacologic interventions on myocardial infarct size following coronary occlusion.

A number of hemodynamic, pharmacologic and metabolic interventions were found to change the extent of acute ischemic injury of the myocardium and subsequent necrosis following experimental coronary artery occlusion. Reduction in myocardial damage occurred by decreasing myocardial oxygen demands (beta-adrenergic blocking agents, intra-aortic balloon counterpulsation, external counterpulsation, nitroglycerin, decreasing afterload in hypertensive patients, inhibition of lipolysis, and digitalis in the failing heart); by increasing myocardial oxygen supply either directly (coronary artery reperfusion or elevating arterial pO2), or through collateral vessels (elevation of coronary perfusion pressure by alpha-adrenergic agonists, intra-aortic balloon counterpulsation); or by increasing plasma osmolality (mannitol, hypertonic glucose); presumably by augmenting anaerobic metabolism (glucose-insulin-potassium, hypertonic glucose); by enhancing transport to the ischemic zone of substrates utilized in energy production (hyaluronidase); by protecting against autolytic and heterolytic damage (hydrocortisone, cobra venom factor, aprotinin). Augmentation of myocardial ischemic damage occurred as a consequence of increasing myocardial oxygen requirements (isoproterenol, glucagon, ouabain, bretylium tosylate, tachycardia); by decreasing myocardial oxygen supply either directly (hypoxia, anemia) or through reduction of collateral flow (hemorrhagic hypotension, minoxidil) or by decreasing substrate availability glycemia). Pilot studies have been carried out in patients with hyaluronidase, nitroglycerin, intra-aortic balloon counterpulsation, beta-blocking agents and Arfonad and have shown that these interventions may also reduce myocardial damage, suggesting that the concept of reduction in infarct size following coronary occlusion is applicable clinically.

Acute Disease↗
PubMed1979

Intra-aortic balloon pumping: two-year experience.

Experience with 29 patients who underwent intra-aortic counterpulsation between January, 1975, and December, 1977, was reviewed to determine (1) if the results of this method of treatment were similar at the community hospital and university hospital levels and (2) if earlier institution of counterpulsation made possible by easy availability of equipment resulted in improved survival. The balloon was successfully inserted in 27 patients. Arterial blood pressure was below 80 mm. Hg in all patients prior to institution of either pharmacologic or balloon therapy. Pulmonary capillary wedge pressure was greater than 12 mm. Hg in the 22 patients in whom it was measured. In 15 patients counterpulsation was instituted less than 12 hours after infarction (Group A), and in the 14 elapsed time was greater than 12 hours (Group B). There was no difference in precounterpulsation hemodynamic measurements between Group A and Group B. Ten patients in Group A were weaned and survived hospitalization. Seven (54 percent) are long-term survivors (6 months to 2 years). Four are in New York Heart Association Class I, two are in Class II, and one is in Class III. Ten patients in Group B were weaned, seven survived hospitalization, and five are long-term survivors (35 percent). Two are in N.Y.H.A. Class I, two are in Class II, and one is in Class III. These results indicate that counterpulsation is possible at the local hospital level and that early institution of the intra-aortic balloon pumping may improve long-term results.

Assisted Circulation↗
PubMed1990

Dynamic aortomyoplasty to assist left ventricular failure.

The efficacy of skeletal muscle contractile force to augment left ventricular function has been demonstrated experimentally and clinically by the cardiomyoplasty procedure. Another approach in biomechanical cardiac assistance is the use of electrostimulated skeletal muscle in an extracardiac position. We describe an autologous counterpulsating device using the native ascending aorta as a ventricular chamber wrapped by an electrostimulated latissimus dorsi muscle flap (LDMF). This model avoids thrombotic complications observed in skeletal muscle neo-ventricles associated with prosthetic chambers. In 8 goats, a right LDMF was transferred to the thoracic cavity by removal of the second rib. In 4 goats, the diameter of the aorta was enlarged by surgical implantation (using lateral clamping) of an autologous pericardial patch. The LDMF was wrapped around the ascending aorta and electrostimulated using an external diastolic pulse generator connected to a sensing myocardial lead and to LDMF pacing electrodes. Hemodynamic studies were performed (left ventricular, aortic, and pulmonary artery pressures and rate of rise of left ventricular pressure). The LDMF diastolic counterpulsation was performed using a burst of 30 Hz, with a delay from the R wave adjusted to provide optimal diastolic augmentation. Percent increase in the subendocardial viability index was calculated during unassisted and assisted cardiac cycles (1:2) at baseline and after acute heart failure induced by the administration of high doses of propranolol hydrochloride (3 mg/kg intravenously). Diastolic aortic counterpulsation by the stimulated LDMF resulted in a significant improvement in the subendocardial viability index both at baseline and after induced cardiac failure in both groups, though the increase was greater in the group with aortic enlargement.

Animals↗
PubMed1990

Effect of circulatory assist devices on stunned myocardium.

We studied the effects of mechanical circulatory assist devices on left ventricular oxygen consumption, the integrals of systolic left ventricular wall stress (SSI), and end-systolic elastance (Ees) in 8 sheep after 25 minutes of global ischemia. Extracorporeal membrane oxygenation at 35 mL/kg/min, intraaortic balloon counterpulsation, and an intraaortic double-balloon pump were studied alone or in combination. Left ventricular oxygen consumption, SSI, and Ees were measured before and during mechanical circulatory assistance. Left ventricular oxygen consumption was calculated from transit-time measurements of left main coronary artery blood flow and fiberoptic measurements of coronary sinus blood oxygen saturation. Three pairs of sonomicrometry crystals placed across three orthogonal ventricular axes were used to calculate instantaneous ventricular volumes and pressure-volume loops from which the SSI data were derived. The Ees was measured using a new single-beat aortic occlusive method. Extracorporeal membrane oxygenation alone increased SSI and did not change Ees in postischemic poorly contracting hearts. Intraaortic balloon counterpulsation alone significantly reduced SSI and increased Ees. The combination of extracorporeal membrane oxygenation and either the intraaortic balloon pump or the intraaortic double-balloon pump reduced SSI, increased Ees, and reduced left ventricular oxygen consumption. In postischemic dilated, poorly contracting hearts, the combination of extracorporeal membrane oxygenation and intraaortic balloon counterpulsation has important advantages over extracorporeal membrane oxygenation alone.

Animals↗
PubMed1994

Long-term effects of dynamic aortomyoplasty.

Aortomyoplasty consists of wrapping the latissimus dorsi muscle (LDM) around the ascending aorta and electrostimulating it during diastole. The ascending aorta will act as an ectopic neo-ventricle compressed during diastole, thus reproducing the effects of long-term diastolic counterpulsation. In 5 goats, the right LDM was transferred to the thoracic cavity after removal of the second rib. The ascending aorta was enlarged by a pericardial patch and wrapped with the LDM. Postoperative electrostimulation was delivered in a counterpulsating manner. Hemodynamic studies were performed at 12 and 24 months postoperatively. Percent increase in the subendocardial viability index (diastolic pressure-time index/systolic tension-time index) was calculated using unassisted and assisted cardiac cycles with the stimulator off versus the stimulator on at a 1:1 ratio in the basal state and after acute heart failure was induced by the administration of high doses of propranolol hydrochloride. Diastolic counterpulsation of the ascending aorta resulted in significant improvement in the subendocardial viability index long term, both in basal state conditions and after induced cardiac failure. During heart failure, aortomyoplasty increased the cardiac output and decreased systemic vascular resistance. Histopathologic studies up to 24 months showed preservation of the histologic structure of the aortic wall and no evidence of thromboembolism. Tight adhesions developed between the aortic wall (including the pericardial patch) and the LDM. The diameters of the enlarged aortas showed no significant differences compared with diameters immediately postoperatively. In conclusion, aortomyoplasty produces chronic diastolic augmentation with preservation of aortic structure. After induction of heart failure, aortomyoplasty offers efficient circulatory support.

Animals↗
PubMed1998

Dynamic aortomyoplasty: clinical experience and thoracoscopic surgery feasibility study.

BACKGROUND: Surgical procedures using the latissimus dorsi (LD) muscle to assist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplasty (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach. MATERIALS AND METHODS: A clinical pilot study on dynamic descending AMP started in June 1995 and included four patients. Two of them could benefit from LD counterpulsation, surviving 6 months and 18 months. Following this clinical experience, we investigated, on an animal model, minimally invasive thoracoscopic surgery for this procedure. Twelve goats underwent endoscopic LD harvest and video-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint. RESULTS: Clinical AMP using open techniques provided extraaortic counterpulsation in NYHA Class IV patients contraindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better patient outcome. Minimally invasive thoracoscopic surgery was feasible and reproducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrated. We concluded that thoracoscopic AMP may provide a minimally invasive approach to cardiac assistance and thus, a new surgical option for patients presenting with chronic heart failure.

Animals↗
PubMed1998

Skeletal muscle ventricles: full versus half aortic ligation.

BACKGROUND: Skeletal muscle ventricles have been shown to provide effective aortic diastolic counterpulsation in an experimental model. Construction has included full ligation of the thoracic aorta. The authors sought to determine if these muscle pumps could function effectively without fully ligating the aorta. METHODS: Skeletal muscle ventricles were constructed in two groups of dogs. Group 1 had their aortas fully ligated (n = 10) while group 2 had their aortas narrowed by 50% (n = 10). The animals were followed for 10 weeks. RESULTS: There was no significant difference in femoral diastolic augmentation at implant or at 10 weeks (19.1% +/- 9.9% in group 1 [full ligation] versus 16.3% +/- 10.2% in group 2 [half ligation] p = 0.502). Survival to 10 weeks was significantly better in group 1 (full ligation). Nine of 10 animals in this group survived versus 4 of 10 in group 2 (p = 0.019). Two animals survived in the half ligation group with effective augmentation and without thrombus formation. CONCLUSION: Both models produce effective diastolic counterpulsation. Survival was decreased in this model using half ligation, and survival without complication was observed in 2 of 10 animals. Currently the overall results are better with the full aortic ligation model. However, design modifications will probably result in an effective model of diastolic counterpulsation without full aortic ligation.

Animals↗
PubMed1989

Lower limb ischemia related to use of the intraaortic balloon pump.

In this prospective study we sought to establish the incidence and nature of lower limb ischemia in patients undergoing treatment with intraaortic balloon pump (IABP) counterpulsation and to determine risk factors for its development. The sample was composed of all 258 balloon catheter insertions or attempted insertions for IABP therapy in 249 patients during a 16-month period. Assessment of the lower limbs, hemodynamic status, and pertinent medications were recorded daily throughout the patient's hospitalization. Lower limb ischemia was present in 47%, with 14% having major ischemic complications. Multivariate logistic regression, which was based on variables found to be significant in univariate analysis, revealed that preexisting peripheral vascular disease, female sex, and diabetes mellitus were related to the development of the whole range of lower limb ischemic problems. Diabetes mellitus, cardiogenic shock, and a history of smoking were associated with major ischemia. Evaluation of risks and benefits before treatment with IABP counterpulsation and careful lower limb assessment before, during, and after counterpulsation may help reduce the complications associated with this lifesaving device.

Adolescent↗
PubMed1989

Benefit of the perfusion catheter for emergency coronary artery grafting after failed percutaneous transluminal coronary angioplasty.

Of 2,102 consecutive patients who underwent percutaneous transluminal coronary angioplasty, 31 (1.5%) had emergency coronary bypass grafting for failed angioplasty. To determine the potential impact of different therapeutic strategies for controlling associated myocardial ischemia, 3 groups were analyzed. Group 1 comprised 11 patients (36%) in whom a "bailout" catheter was used to maintain anterograde coronary perfusion, group 2 included 16 patients (52%) in whom only intraaortic balloon counterpulsation was used and group 3 contained 4 patients (13%) in whom neither bailout catheter nor intraaortic balloon was used. Despite a longer average time to cardiopulmonary bypass, patients managed with the bailout catheter had a significantly lower incidence of Q-wave myocardial infarctions (9 vs 75%, p less than 0.05) compared with patients managed with intraaortic balloon counterpulsation alone. Those managed with the bailout catheter also had more consistent resolution of ST elevation and greater use of internal mammary artery grafts than patients supported by intraaortic balloon counterpulsation alone.

Aged↗
PubMed1983

Comparison of wire-guided percutaneous insertion and conventional surgical insertion of intra-aortic balloon pumps in 151 patients.

Over a 25-month period, percutaneous wire-guided balloon catheter insertion was attempted in 51 patients, and intra-aortic balloon pump insertion was attempted by conventional surgical method in 100 patients. The success rate in the group undergoing percutaneous insertion was 90.2 percent (46 of 51) and 90 percent in the group undergoing surgical insertion (90 of 100). The indications for intra-aortic balloon counterpulsation were diverse in both groups. The major complication rate in the patient population undergoing percutaneous intra-aortic balloon pump insertion was 15.2 versus 15.6 percent for the surgical group, and there were no cases of leg amputation or aortic dissection in the percutaneous group; however, two cases of leg amputation and one case of aortic dissection resulting in death occurred in the surgical group. The percutaneous intra-aortic balloon pump insertion technique was successfully employed in conjunction with percutaneous transluminal coronary angioplasty in six cases. It is concluded that the wire-guided percutaneous balloon catheter method is a highly successful and rapid means of instituting intra-aortic balloon counterpulsation in a wide variety of clinical situations. However, because of the significant associated complication rate, the decision to institute balloon counterpulsation must weigh the benefit-to-risk ratio, and this procedure must still be evaluated on a case-by-case basis.

Adult↗
PubMed1996

Effects of intraaortic balloon pumping on coronary and carotid flow during percutaneous cardiopulmonary support.

Previous studies have suggested an improved clinical outcome when percutaneous cardiopulmonary support is combined with intraaortic balloon counterpulsation in patients with cardiogenic shock. We evaluated the effect of combined intraaortic balloon counterpulsation and percutaneous cardiopulmonary support therapy on coronary and cerebral blood flow by Doppler measurements in the coronary and the carotid arteries in a patient with cardiac arrest. During pacemaker stimulation, intraaortic balloon counterpulsation in addition to percutaneous cardiopulmonary support markedly improved coronary and carotid blood flow. Possible mechanisms are discussed.

Cardiac Pacing, Artificial↗