1
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Kodack E, Patel R, Bonner C, Pantin E. A complication of an axillary intra-aortic balloon pump. J Surg Case Rep 2024; 2024:rjae092. [PMID: 38455981 PMCID: PMC10915356 DOI: 10.1093/jscr/rjae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 03/09/2024] Open
Abstract
Intra-aortic balloon pumps (IABPs) are used to mechanically temporize a failing heart by decreasing afterload while increasing coronary perfusion pressure of the heart while more definitive treatment is sought. We report a case of a 65-year-old male with nonischemic cardiomyopathy, atrial fibrillation, thyroiditis, and non-Hodgkin lymphoma who presented with worsening heart failure. He underwent a percutaneous placement of a left axillary IABP with seemingly no complications. Approximately 3 weeks post-placement, the patient was taken for a heart transplant when an intraoperative transesophageal echo showed that the IABP was in the aortic arch and ascending aorta, instead of its proper placement in the descending aorta. The patient's arterial line showed waveforms appropriate for an IABP patient, and the patient showed no signs indicative of improper placement. This erroneous placement carried the potential to affect the aortic valve function, injure the aortic intima and/or occlude the aortic arch vessels. .
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Affiliation(s)
- Eileen Kodack
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Riya Patel
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, United States
| | - Carain Bonner
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Enrique Pantin
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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2
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Wienen D, Gries T, Cooper SL, Heath DE. An overview of polyurethane biomaterials and their use in drug delivery. J Control Release 2023; 363:376-388. [PMID: 37734672 DOI: 10.1016/j.jconrel.2023.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
Polyurethanes are a versatile and highly tunable class of materials that possess unique properties including high tensile strength, abrasion and fatigue resistance, and flexibility at low temperatures. The tunability of polyurethane properties has allowed this class of polymers to become ubiquitous in our daily lives in fields as diverse as apparel, appliances, construction, and the automotive industry. Additionally, polyurethanes with excellent biocompatibility and hemocompatibility can be synthesized, enabling their use as biomaterials in the medical field. The tunable nature of polyurethane biomaterials also makes them excellent candidates as drug delivery vehicles, which is the focus of this review. The fundamental idea we aim to highlight in this article is the structure-property-function relationships found in polyurethane systems. Specifically, the chemical structure of the polymer determines its macroscopic properties and dictates the functions for which it will perform well. By exploring the structure-property-function relationships for polyurethanes, we aim to elucidate the fundamental properties that can be tailored to achieve controlled drug release and empower researchers to design new polyurethane systems for future drug delivery applications.
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Affiliation(s)
- David Wienen
- Institute of Textile Technology, RWTH Aachen, Germany
| | - Thomas Gries
- Institute of Textile Technology, RWTH Aachen, Germany
| | - Stuart L Cooper
- Department of Chemical and Biomolecular Engineering, The Ohio State University, USA
| | - Daniel E Heath
- Department of Biomedical Engineering, Graeme Clark Institute, University of Melbourne, Australia.
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3
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Khalid N, Ahmad SA. Editorial: Adverse events from intra-aortic balloon counterpulsation therapy: Insights from the MAUDE database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:41-42. [PMID: 37544803 DOI: 10.1016/j.carrev.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Nauman Khalid
- Section of Interventional Cardiology, St. Francis Medical Center, Monroe, LA, USA.
| | - Sarah Aftab Ahmad
- Section of Cardiothoracic Surgery, St. Francis Medical Center, Monroe, LA, USA
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4
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Milne B, Dalzell J, Kunst G. Management of cardiogenic shock after acute coronary syndromes. BJA Educ 2023; 23:172-181. [PMID: 37124173 PMCID: PMC10140595 DOI: 10.1016/j.bjae.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- B. Milne
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - G. Kunst
- King's College Hospital NHS Foundation Trust, London, UK
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5
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Salter BS, Gross CR, Weiner MM, Dukkipati SR, Serrao GW, Moss N, Anyanwu AC, Burkhoff D, Lala A. Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Nat Rev Cardiol 2023; 20:263-277. [PMID: 36357709 PMCID: PMC9649020 DOI: 10.1038/s41569-022-00796-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/12/2022]
Abstract
Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread in a variety of clinical settings in the contemporary era. Their use as a short-term, prophylactic support vehicle has expanded to include procedures in the catheterization laboratory, electrophysiology suite, operating room and intensive care unit. Accordingly, MCS device design and technology continue to develop at a rapid pace. In this Review, we describe the functionality, indications, management and complications associated with temporary MCS, together with scenario-specific utilization, goal-directed development and bioengineering of future devices. We address various considerations for the use of temporary MCS devices in both prophylactic and rescue scenarios, with input from stakeholders from various cardiovascular specialties, including interventional and heart failure cardiology, electrophysiology, cardiothoracic anaesthesiology, critical care and cardiac surgery.
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Affiliation(s)
- Benjamin S Salter
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Caroline R Gross
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Menachem M Weiner
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory W Serrao
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA
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6
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Martinez T, Jahren SE, Walter A, Chavanne J, Clavica F, Ferrari L, Heinisch PP, Casoni D, Haeberlin A, Luedi MM, Obrist D, Carrel T, Civet Y, Perriard Y. A novel soft cardiac assist device based on a dielectric elastomer augmented aorta: An in vivo study. Bioeng Transl Med 2023; 8:e10396. [PMID: 36925677 PMCID: PMC10013878 DOI: 10.1002/btm2.10396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/12/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022] Open
Abstract
Although heart transplant is the preferred solution for patients suffering from heart failures, cardiac assist devices remain key substitute therapies. Among them, aortic augmentation using dielectric elastomer actuators (DEAs) might be an alternative technological application for the future. The electrically driven actuator does not require bulky pneumatic elements (such as conventional intra-aortic balloon pumps) and conforms tightly to the aorta thanks to the manufacturing method presented here. In this study, the proposed DEA-based device replaces a section of the aorta and acts as a counterpulsation device. The feasibility and validation of in vivo implantation of the device into the descending aorta in a porcine model, and the level of support provided to the heart are investigated. Additionally, the influence of the activation profile and delay compared to the start of systole is studied. We demonstrate that an activation of the DEA just before the start of systole (30 ms at 100 bpm) and deactivation just after the start of diastole (0-30 ms) leads to an optimal assistance of the heart with a maximum energy provided by the DEA. The end-diastolic and left ventricular pressures were lowered by up to 5% and 1%, respectively, compared to baseline. The early diastolic pressure was augmented in average by up to 2%.
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Affiliation(s)
- Thomas Martinez
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland
| | - Silje Ekroll Jahren
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland.,ARTORG Center for Biomedical Engineering Research University of Bern Bern Switzerland
| | - Armando Walter
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland
| | - Jonathan Chavanne
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland
| | - Francesco Clavica
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland.,ARTORG Center for Biomedical Engineering Research University of Bern Bern Switzerland
| | - Lorenzo Ferrari
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland.,ARTORG Center for Biomedical Engineering Research University of Bern Bern Switzerland
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich Technical University of Munich Munich Germany.,Division of Congenital and Pediatric Heart Surgery University Hospital of Munich, Ludwig-Maximilians-University Munich Germany
| | - Daniela Casoni
- Experimental Surgery Facility University of Bern Bern Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Bern University Hospital Inselspital University of Bern Bern Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital University of Bern Bern Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research University of Bern Bern Switzerland
| | - Thierry Carrel
- Department of Cardiac Surgery University of Zurich Zurich Switzerland
| | - Yoan Civet
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland
| | - Yves Perriard
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL) Neuchâtel Switzerland
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7
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Mohamed A, Aboulnaga S, Hamwi F, Omar AS, Pattath A, Singh R, Alkhulaifi A. The influence of intra-aortic balloon counter pulsation on central venous blood oxygen saturation. Perfusion 2023; 38:353-362. [PMID: 34894852 DOI: 10.1177/02676591211055968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aim at identifying the changes in venous blood saturation values that associates intra-aortic balloon pump (IABP) in cardiac surgery patients with reduced left ventricular function (LVF). METHODS A retrospective observational study was conducted in a cardiothoracic intensive care unit (CTICU) in a tertiary cardiac center over 5 years in Qatar. A total of 114 patients with at least moderate impairment of LVF with ejection fraction (EF) less than 40% were enrolled. According to the association of IABP, patients were segregated into two groups with and without IABP (groups 1, 40 patients and group 2, 74 patients). Sequential arterial and venous blood gases were analyzed. The primary outcome was to analyze the changes in the central venous saturation (ScvO2) in both groups and the secondary outcome was to analyze whether these changes affect the overall outcome in terms of intensive care unit (ICU) length of stay. RESULTS There was no significant difference between both groups with regard to age, preoperative EF, hemoglobin, and arterial oxygen saturation (SaO2) in blood gases. Patients with IABP have a higher cScvO2 when compared to the other group (71.5 ± 12.5 vs 63.5 ± 9.3, 68.3 ± 12.6 vs 60.1 ± 9.5, 62.7 ± 10.8 vs 55.63 ± 8.1, and 60.6 ± 7.6 vs 54.9 ± 8.1; p = 0.04, 0.05, 0.03, and 0.5, respectively). However, generalized estimating equations (GEE) analysis showed that compared with the participants showing that there is a decreasing trend in mean levels within the groups during follow-ups, overall difference between both groups' mean levels was not statistically significant. CONCLUSIONS In this study, we observed that after cardiac surgeries, patients with IABP had non-significant higher ScvO2 when compared with a corresponding group with moderate impairment of LVF. Further prospective studies are required to validate these findings.
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Affiliation(s)
- Ayman Mohamed
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar.,Department of Anesthesia and Intensive Care, Al-Azhar University, Cairo, Egypt
| | - Sameh Aboulnaga
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar.,Department of Anesthesia and Intensive Care, Ain Shams University, Cairo, Egypt
| | - Fayez Hamwi
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar
| | - Amr S Omar
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar.,Department of Critical Care Medicine, Beni Suef University, Beni Suef, Egypt.,Weill Cornell Medical College, Ar-Rayyan, Qatar
| | - Abdulrasheed Pattath
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar
| | | | - Abdulaziz Alkhulaifi
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar
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8
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Patnaik S, Nathan S, Bui A, Kar B, Gregoric ID, Gilley CB. Impact of structured physical therapy protocol among heart transplant recipients while on intra-aortic balloon pump in the pretransplant period. Artif Organs 2023; 47:198-204. [PMID: 35943826 DOI: 10.1111/aor.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Use of prolonged femoral intra-aortic balloon pump support limits the mobility of patients awaiting heart transplant. We assessed the safety and outcomes of a structured, tilting physical therapy protocol in patients supported by intra-aortic balloon pumps while awaiting transplant. METHODS We retrospectively reviewed five years of transplant patients. Eighteen patients received femoral intra-aortic balloon support, a heart transplant, and met all eligibility criteria. We compared complications and outcomes between patients who received the structured, tilting physical therapy (Protocol Group) and those that received standard of care (Control Group). RESULTS Complications were not significantly different between groups. The majority of the Protocol Group were discharged to home (10/12), while half (3/6) of the Control Group were discharged to a rehabilitation facility. Post-transplant length of stay was significantly less in the Protocol Group (median 16 vs. 28 days, p = 0.03). CONCLUSION Despite the small number analyzed, the data indicates that the structured, tilting physical therapy protocol led to a significantly reduced length of stay post-transplantation. Importantly, use of the protocol did not result in access site complications, thrombosis, or arrhythmias in the majority of the patients.
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Affiliation(s)
- Soumya Patnaik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amanda Bui
- Department of Physical Therapy, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christa Bauer Gilley
- Department of Physical Therapy, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA
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9
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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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10
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Prevention and Management of AKI in ACS Patients Undergoing Invasive Treatments. Curr Cardiol Rep 2022; 24:1299-1307. [PMID: 35925513 DOI: 10.1007/s11886-022-01742-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of patients presenting with acute coronary syndrome (ACS) includes invasive procedures that may increase the risk of acute kidney injury (AKI). AKI adversely affects the outcomes of such procedures and complicates the management of ACS. We have summarized several strategies for the prevention and management of AKI in this critical patient group including in the pre-procedural, intraprocedural, and post-procedural settings. RECENT FINDINGS Definitive prevention and management strategies for AKI in patients presenting with ACS requiring invasive management can be confounded by the variation in data outcomes. Pre-procedural hydration with normal saline when accounting for time to catheterization, radial artery access, contrast stewardship, and close monitoring of renal function after catheterization should be implemented.
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11
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Manshadi SD, Eisenberg N, Montbriand J, Luk A, Roche-Nagle G. Vascular Complications with Intra-Aortic Balloon Pump (IABP) – Experience from a large Canadian metropolitan centre. CJC Open 2022; 4:989-993. [DOI: 10.1016/j.cjco.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022] Open
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12
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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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13
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Kidson KM, Lapinsky S, Grewal J. A Detailed Review of Critical Care Considerations for the Pregnant Cardiac Patient. Can J Cardiol 2021; 37:1979-2000. [PMID: 34534620 DOI: 10.1016/j.cjca.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023] Open
Abstract
Maternal cardiovascular disease is a leading cause of maternal death worldwide and recently, maternal mortality has increased secondary to cardiovascular causes. Maternal admissions to critical care encompass 1%-2% of all critical care admissions, and although not common, the management of the critically ill pregnant patient is complex. Caring for the critically ill pregnant cardiac patient requires integration of pregnancy-associated physiologic changes, understanding pathophysiologic disease states unique to pregnancy, and a multidisciplinary approach to timing around delivery as well as antenatal and postpartum care. Herein we describe cardiorespiratory changes that occur during pregnancy and the differential diagnosis for cardiorespiratory failure in pregnancy. Cardiorespiratory diseases that are either associated or exacerbated by pregnancy are highlighted with emphasis on perturbations secondary to pregnancy and appropriate management strategies. Finally, we describe general management of the pregnant cardiac patient admitted to critical care.
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Affiliation(s)
- Kristen M Kidson
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Stephen Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Grewal
- Division of Cardiology, University of British Columbia, Pacific Adult Congenital Heart Disease Program, St Paul's Hospital, Vancouver, British Columbia, Canada.
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14
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Central Versus Peripheral Arterial Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation in Post-Cardiotomy Patients. ASAIO J 2021; 67:67-73. [PMID: 33346992 DOI: 10.1097/mat.0000000000001202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Different arterial cannulation strategies are feasible for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in postcardiotomy shock. We aimed to analyze potential benefits and safety of different arterial cannulation strategies. We identified 158 patients with postcardiotomy cardiogenic shock requiring VA-ECMO between 01/10 and 01/19. Eighty-eight patients were cannulated via axillary or femoral artery (group P), and 70 centrally via the ascending aorta directly or through an 8 mm vascular graft anastomosed to the ascending aorta (group C). Demographics and operative parameters were similar. Change of cannulation site for Harlequin's syndrome or hyperperfusion of an extremity occurred in 13 patients in group P but never in group C (p = 0.001). Surgical revision of cannulation site was also encountered more often in group P than C. The need for left ventricular (LV) unloading was similar between groups, whereas surgical venting was more often implemented in group C (11.4% vs. 2.3, p = 0.023). Stroke rates, renal failure, and peripheral ischemia were similar. Weaning rate from ECMO (52.9% vs. 52.3%, p = NS) was similar. The 30 day mortality was higher in group P (60% vs. 76.1%, p = 0.029). Central cannulation for VA-ECMO provides antegrade flow without Harlequin's syndrome, changes of arterial cannula site, and better 30 day survival. Complication rates regarding need for reexploration and transfusion requirements were similar.
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15
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Coppel J, Rosenberg A, Gilbert-Kawai E. An introduction to mechanical circulatory support in cardiac intensive care. Br J Hosp Med (Lond) 2021; 81:1-9. [PMID: 32339012 DOI: 10.12968/hmed.2020.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
While use of mechanical circulatory support is increasing, knowledge of its fundamental role and limitations remains poorly understood by many medical professionals. This article summarises the main types of mechanical circulatory support and how they work, particularly focusing on the key information medical professionals should know should they encounter them in hospital. Mechanical circulatory support can be an effective treatment modality in selected pathologies, including myocardial ischaemia, pulmonary congestion, massive pulmonary embolic disease, postcardiotomy cardiogenic shock with failure to wean off bypass, right ventricular failure, bridge to heart and lung transplant and, increasingly, extracorporeal cardiopulmonary resuscitation. Intra-aortic balloon pumps increase coronary perfusion and reduce myocardial oxygen demand in a variety of cardiac conditions. Extracorporeal membrane oxygenation can provide both respiratory and circulatory support to patients. Ventricular assist devices can provide support for not only patients with acute cardiogenic shock, but also for ambulant patients in the community setting.
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Affiliation(s)
- Jonny Coppel
- Department of Intensive Care Medicine, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Alex Rosenberg
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Edward Gilbert-Kawai
- Department of Intensive Care Medicine, The Royal London Hospital, Barts Health NHS Trust, London, UK
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16
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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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17
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de Jong MMJ, Parise O, Matteucci F, Tetta C, Maessen JG, Gelsomino S. Superior mesenteric flow pattern during counterpulsation: is simply a shorter balloon the solution for visceral hypoperfusion? Interact Cardiovasc Thorac Surg 2020; 30:121-128. [PMID: 31578569 DOI: 10.1093/icvts/ivz230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/31/2019] [Accepted: 08/11/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We studied the flow pattern in the superior mesenteric artery (SMA) during intra-aortic balloon pump support, comparing 2 intra-aortic balloons of 2 different lengths. METHODS Sixteen Landrace pigs (mean weight 84.0 kg ± 6.0) were used in this study. The animals were randomly assigned to 2 groups: group 1 received an 8-Fr, 40-ml standard balloon; group 2 received an 8-Fr, 40-ml short balloon. SMA flow was measured during early, mid- and telediastole. RESULTS The standard balloon led to a reduction in SMA flow in early diastole (P < 0.001), a negative flow in mid-diastole (P < 0.001) and a reincrease in telediastole (P < 0.001). In contrast, in early diastole a significant reduction was observed with the short balloon (P < 0.001), followed by another drop in mid-diastole (P < 0.001), without reaching negative values and by a telediastolic increase (P < 0.001). SMA flows were comparable between balloons during early diastole (P = 0.66), whereas they were higher with the short balloon during mid (P < 0.001) and telediastole (P = 0.02). Overall, the diastolic area was significantly larger when the short balloon was used (P < 0.001). Finally, during counterpulsation, mesenteric resistances increased significantly (P < 0.001), although, with the short balloon, they were lower than with the standard balloon (P = 0.01). CONCLUSIONS Despite better overall mean mesenteric diastolic flow, the short balloon leads to early- and mid-diastolic flow reduction, although to a lesser extent than the standard intra-aortic balloon pump balloon. Our data are a call for improvement in the design of the short balloon.
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Affiliation(s)
- Monique M J de Jong
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Orlando Parise
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Francesco Matteucci
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Cecilia Tetta
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
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18
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Wu T, Khir AW, Kütting M, Du X, Lin H, Zhu Y, Hsu PL. A review of implantable pulsatile blood pumps: Engineering perspectives. Int J Artif Organs 2020; 43:559-569. [PMID: 32037940 DOI: 10.1177/0391398820902470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been reported that long-term use of continuous-flow mechanical circulatory support devices (CF-MCSDs) may induce complications associated with diminished pulsatility. Pulsatile-flow mechanical circulatory support devices (PF-MCSDs) have the potential of overcoming these shortcomings with the advance of technology. In order to promote in-depth understanding of PF-MCSD technology and thus encourage future mechanical circulatory support device innovations, engineering perspectives of PF-MCSD systems, including mechanical designs, drive mechanisms, working principles, and implantation strategies, are reviewed in this article. Some emerging designs of PF-MCSDs are introduced, and possible elements for next-generation PF-MCSDs are identified.
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Affiliation(s)
- Tingting Wu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | | | - Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | - Hao Lin
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Yuxin Zhu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Po-Lin Hsu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
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19
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Macapagal FR, McClellan E, Macapagal RO, Green L, Bonuel N. Nursing Care and Treatment of Ambulatory Patients With Percutaneously Placed Axillary Intra-aortic Balloon Pump Before Heart Transplant. Crit Care Nurse 2019; 39:45-52. [PMID: 30936130 DOI: 10.4037/ccn2019729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Transplant cardiologists in our hospital have performed the percutaneously placed axillary-subclavian intra-aortic balloon pump procedure since 2007. This procedure allows patients to mobilize and walk while they wait for a heart transplant, rather than remaining on bed rest as they would with a traditional femoral intra-aortic balloon pump. This procedure has presented challenges to the nursing staff. A 2007 literature search revealed no precedent or published nursing articles on this subject. This article reviews heart failure, medical treatments, complications of bed rest associated with the femoral intra-aortic balloon pump, the nursing challenges and unique problems of caring for patients with percutaneously placed axillary-subclavian intra-aortic balloon pumps, and our solutions for those challenges.
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Affiliation(s)
- Frederick R Macapagal
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. .,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital. .,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital. .,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital. .,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas.
| | - Emma McClellan
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
| | - Rosario O Macapagal
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
| | - Lisa Green
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
| | - Nena Bonuel
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
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20
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Nevzorov R, Daum A, Jafari J, Yosefy C, Gallego-Colon E. Impact of the Change in ESC Guidelines on Clinical Characteristics and Outcomes of Cardiogenic Shock Patients Receiving IABP Therapy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:46-51. [PMID: 31759912 DOI: 10.1016/j.carrev.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intra-aortic balloon pump (IABP) counterpulsation provides mechanical support for patients with cardiogenic shock. The aim of the study is to evaluate the clinical characteristics and outcomes of patients with cardiogenic shock receiving IABP before and after the European Society of Cardiology (ESC) downgraded the use of IABP from a class I to a class IIb in 2012. METHODS Data was obtained from the Acute Coronary Syndrome Israeli Survey (ACSIS) registry, a prospective observational national survey conducted once every two years. From a total of 15,200 patients with acute coronary syndrome (ACS), 524 patients were identified with acute myocardial infarction (AMI)-complicated with cardiogenic shock. The groups were further subdivided based on whether the IABP was implanted before or after the change in guideline recommendation. RESULTS The study indicates a 24% reduction in IABP use since 2002. Until 2012, a reduction in clinical outcomes including 7-days, 30-days and in-hospital mortality, was observed in patients with IABP compared to the patients with conventional therapy. Conversely, after the ESC changed the guidelines, the clinical outcomes were not improved by IABP treatment. Additionally, the conventional therapy group presented with higher baseline ejection fraction, received less effective treatment, reperfusion and/or pharmacological therapy than patients with IABP. CONCLUSION The use of IABP as management for cardiogenic shock has diminished over time since the guidelines were modified. After the change in guidelines, the use of IABP is restricted to high-risk, severely compromised and hemodynamically deteriorated patients hence limiting beneficial outcomes.
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Affiliation(s)
- Roman Nevzorov
- Cardiology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Aner Daum
- Cardiology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Jamal Jafari
- Cardiology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Chaim Yosefy
- Cardiology Department, Barzilai University Medical Center, Ashkelon, Israel
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21
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Intra-Aortic Balloon Pump for Patients with Cardiac Conditions: An Update on Available Techniques and Clinical Applications. REPORTS 2019. [DOI: 10.3390/reports2030019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this paper, we present a review of the intra-aortic balloon pump, as well as the usage of it in the medical field today. An intra-aortic balloon pump (IABP) is a biomedical device that can assist the heart during unstable angina or after a heart attack. This pump is typically used in patients who suffer from ischemia of the heart tissue, due to an unbalanced level of myocardial oxygen supply or demand. Through counterpulsation, which is a technique to synchronize the external pumping of blood with the heart’s cycle, the device can balance the supply and demand of blood that is necessary for the heart to pump properly. The IABP is comprised of the following four components: a polyurethane balloon, a polyethylene or fiber-optic catheter, a transducer, and the intra-aortic balloon pump console. In the past, researchers have used other materials that have low biocompatibility and can cause complications within the body. This analysis will explain the complications and state changes that occurred due to them. Limitations of past designs and advantages of current designs will be acknowledged, for they can be used by researchers to enhance designs for the future. Consequently, the analysis of this device may lead to improved designs and treatment in the future for patients with cardiac conditions.
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22
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Eliaz R, Turyan A, Beeri R, Shuvy M. Utilization of intra-aortic balloon pump to allow MitraClip procedure in patients with non-coapting mitral valve leaflets: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5488151. [PMID: 31449623 PMCID: PMC6601202 DOI: 10.1093/ehjcr/ytz045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/04/2019] [Indexed: 11/13/2022]
Abstract
Background The MitraClip (MC) procedure was designed for high-risk surgical patients with severe mitral regurgitation (MR). Some patients do not meet the required anatomical criteria due to advanced left ventricular remodelling and mitral annular dilatation leading to leaflet tethering and insufficient coaptation surface. Theoretically, ‘temporary remodelling’ of the mitral valve apparatus by pharmacological and/or mechanical support using intra-aortic balloon pump (IABP) could improve leaflets coaptation. Case summary We report a case series of four patients with severe MR and non-coapting leaflets who underwent MC implantation. Sufficient coaptation was achieved only after insertion of IABP. The first patient presented with worsening heart failure and severe MR after a non-reperfused posterior wall myocardial infarction (MI), underwent a successful procedure with good results. The second patient presented with worsening heart failure secondary to rheumatic MR, and underwent MC procedure with good results after the insertion of IABP. The third patient developed worsening heart failure and severe MR 2 months after an acute inferior-lateral MI, and underwent a successful procedure. The fourth patient presented with respiratory failure, the patient underwent the procedure, but unfortunately died a few days following the procedure from multiorgan failure. In each case, the insertion of the IABP decreased annular mitral diameter and increased the coaptation surface as assessed by transoesophageal echocardiography. Discussion For patients suffering from symptomatic severe MR who are not suitable candidates for MC procedure, IABP system enabled us to overcome mitral leaflet gap and complete the MC procedure successfully.
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Affiliation(s)
- Ran Eliaz
- Heart Institute,Hadassah - Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, Israel
| | - Anna Turyan
- Heart Institute,Hadassah - Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, Israel
| | - Ronen Beeri
- Heart Institute,Hadassah - Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, Israel
| | - Mony Shuvy
- Heart Institute,Hadassah - Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, Israel
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23
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Johnson DM, Lozekoot P, de Jong M, Parise O, Makhoul M, Matteucci F, Lucà F, Maessen JG, Gelsomino S. Superior mesenteric and renal flow patterns during intra-aortic counterpulsation. Exp Physiol 2019; 104:643-653. [PMID: 30821049 DOI: 10.1113/ep086810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/27/2019] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Visceral ischaemia is one of the most feared complications during use of an intra-aortic balloon pump. Using an animal model, we measured the flows at the abdominal level directly and examined flow patterns to enable investigation of flow patterns during the use of the intra-aortic balloon pump. What is the main finding and its importance? We show that there is a significant balloon-related reduction in superior mesenteric flow in both early and mid-diastole. ABSTRACT A number of previous studies have shown that blood flow in the visceral arteries is altered during intra-aortic balloon pump (IABP) treatment. We used a porcine model to analyse the pattern of blood flow into the visceral arteries during IABP use. For this purpose, we measured the superior mesenteric, right renal and left renal flows before and during IABP support, using surgically placed flowmeters surrounding these visceral arteries. The superior mesenteric flow significantly decreased in early diastole (P < 0.001) and in mid-diastole (P = 0.003 versus early diastole), whereas in late diastole it increased again (P < 0.001 versus mid-diastole). During systole, the flow was not significantly increased compared with late diastole (P = 0.51), but it was significantly lower than at baseline (both P < 0.001). Flows did not differ between right and left kidneys. Perfusion of either kidney did not change significantly in early diastole (P > 0.05), whereas it decreased significantly in mid-diastole (P < 0.001), rising dramatically in late diastole (P < 0.001) and with an additional slight increase in systole (P = 0.054). This study provides important insights into abdominal flows during intra-aortic pump counterpulsation. Furthermore, it supports the need to rethink the balloon design to avoid visceral ischaemia during circulatory assistance.
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Affiliation(s)
- Daniel M Johnson
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Pieter Lozekoot
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Monique de Jong
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Orlando Parise
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Maged Makhoul
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands.,Cardiothoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Francesco Matteucci
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Fabiana Lucà
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
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24
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Ghia S, Dhawan R, Chaney MA, Jeevanandam V, Stone M, Pawale A, Sladen RN. Can I Go Home With That Balloon Pump? J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.01.021] [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] [Indexed: 11/11/2022]
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25
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Kim CH, Song KS, Trayanova NA, Lim KM. Computational prediction of the effects of the intra-aortic balloon pump on heart failure with valvular regurgitation using a 3D cardiac electromechanical model. Med Biol Eng Comput 2017; 56:853-863. [PMID: 29058110 PMCID: PMC5906536 DOI: 10.1007/s11517-017-1731-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 10/04/2017] [Indexed: 11/20/2022]
Abstract
Intra-aortic balloon pump (IABP) is normally contraindicated in significant aortic regurgitation (AR). It causes and aggravates pre-existing AR while performing well in the event of mitral regurgitation (MR). Indirect parameters, such as the mean systolic pressure, product of heart rate and peak systolic pressure, and pressure–volume are used to quantify the effect of IABP on ventricular workload. However, to date, no studies have directly quantified the reduction in workload with IABP. The goal of this study is to examine the effect of IABP therapy on ventricular mechanics under valvular insufficiency by using a computational model of the heart. For this purpose, the 3D electromechanical model of the failing ventricles used in previous studies was coupled with a lumped parameter model of valvular regurgitation and the IABP-treated vascular system. The IABP therapy was disturbed in terms of reducing the myocardial tension generation and contractile ATP consumption by valvular regurgitation, particularly in the AR condition. The IABP worsened the problem of ventricular expansion induced as a result of the regurgitated blood volume during the diastole under the AR condition. The IABP reduced the LV stroke work in the AR, MR, and no regurgitation conditions. Therefore, the IABP helped the ventricle to pump blood and reduced the ventricular workload. In conclusion, the IABP partially performed its role in the MR condition. However, it was disturbed by the AR and worsened the cardiovascular responses that followed the AR. Therefore, this study computationally proved the reason for the clinical contraindication of IABP in AR patients.
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Affiliation(s)
- Chang-Hyun Kim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk, 39253, Republic of Korea
| | - Kwang-Soup Song
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk, 39253, Republic of Korea
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ki Moo Lim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk, 39253, Republic of Korea.
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26
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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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27
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Sodhi N, Lasala JM. Mechanical Circulatory Support in Acute Decompensated Heart Failure and Shock. Interv Cardiol Clin 2017; 6:387-405. [PMID: 28600092 DOI: 10.1016/j.iccl.2017.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An array of interventional therapeutics is available in the modern era, with uses depending on acute or chronic situations. This article focuses on support in acute decompensated heart failure and cardiogenic shock, including intra-aortic balloon pumps, continuous aortic flow augmentation, and extra-corporeal membrane oxygenation.
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Affiliation(s)
- Nishtha Sodhi
- Cardiovascular Division, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - John M Lasala
- Cardiovascular Division, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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28
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Abstract
In the setting of mechanical circulatory support devices, including ventricular assist devices, extracorporeal membrane oxygenation, intraaortic balloon pumps, and the total artificial heart, the spectral Doppler waveform is significantly altered, reflecting systemic hemodynamic changes. As the prevalence of these devices increases, a better understanding of both the devices themselves and their associated Doppler ultrasound findings is necessary for accurate image interpretation. This article reviews the clinical indications, pathophysiology, and sonographic findings of these devices, with emphasis on the variation in arterial Doppler waveforms that can be seen with normal function, as well as the major complications.
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29
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Abubaih A, Weissman C. Anesthesia for Patients with Concomitant Sepsis and Cardiac Dysfunction. Anesthesiol Clin 2017; 34:761-774. [PMID: 27816133 DOI: 10.1016/j.anclin.2016.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters. Such patients have increased mortality because of their inability to adequately compensate for the cardiovascular changes caused by sepsis.
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Affiliation(s)
- Abed Abubaih
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel.
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30
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A New 35-mm Short Intra-aortic Balloon Catheter: A Suitable Option Also for Non-Small-Sized Patients? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:46-53; discussion 53. [PMID: 26901748 DOI: 10.1097/imi.0000000000000233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Visceral ischemia can be a potentially life-threatening complication of intra-aortic balloon pump (IABP) support. A shorter IABP catheter might lead to a reduction of visceral complications. In this animal study, we evaluate the effects of a 35-mL short catheter in comparison with a 40-mL standard-sized catheter. METHODS Eighteen healthy swine underwent 120-minute ligation of the left anterior descending coronary artery followed by 6 hours of reperfusion being supported by either a short IABP catheter (short group) (n = 6) or a long IABP catheter (long group) (n = 6) or with no assistance (controls) (n = 6). Hemodynamics, visceral and coronary flows, as well as biochemical markers were evaluated throughout the different phases of the protocol. RESULTS Mesenteric flows increased significantly at reperfusion (P < 0.001 both) remaining constant afterward (all, P > 0.05) in the short group, while remaining significantly lower in the long group at the start of reperfusion, remaining constantly lower than the short group and controls (P < 0.001 vs short, P < 0.003 vs controls). In both long and short groups, catheters improved renal flows at reperfusion (P < 0.001 both) without any further variation (P > 0.05). In the short group, the flows were higher during the whole of reperfusion (all, P < 0.05). Intra-aortic balloon pump support improved hemodynamic indices and coronary blood flows during reperfusion to a similar extent in both the small and the long group (P > 0.05). CONCLUSIONS The short IABP catheter proved to be as effective as the standard-sized catheter in supporting hemodynamics and coronary circulation. Furthermore, it even improves visceral flows in comparison with conventional IABP catheters.
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Influence of IABP-Induced Abdominal Occlusions on Aortic Hemodynamics: A Patient-Specific Computational Evaluation. ASAIO J 2016; 63:161-167. [PMID: 27861423 DOI: 10.1097/mat.0000000000000479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Intraaortic balloon pump (IABP) is used as temporary mechanical assistance in case of cardiovascular diseases, even if different hemodynamic problems and, thus, clinical complications may happen, such as the decrease of visceral perfusion. A computational fluid dynamic (CFD) study was carried out to investigate the effects of different IABP-induced abdominal occlusions on patient-specific aortic flow. Two possible sizes (25 and 34 cm) and two locations (2 and 3 cm) of the balloon were compared, modeling four abdominal occlusions and numerically reproducing IAB inflation/deflation behavior. The results highlighted that the perfusion in renal, mesenteric, and iliac arteries decreases when the abdominal occlusion increases with balloon inflation. The study illustrates also how the balloon size affects the flow in aorta vessels in both locations, and that the positioning is of little relevance for the 34 cm balloon, whereas it influences the aortic flow very much in case of 25 cm IAB. This analysis demonstrates how the IAB-induced occlusion may vary the abdominal circulation; therefore, the correct size and positioning are emphasized for patient's outcome.
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Liu CW, Liao PC, Chen KC, Chiu YW, Liu YH, Ke SR, Wu YW. Relationship of serum uric acid and Killip class on mortality after acute ST-segment elevation myocardial infarction and primary percutaneous coronary intervention. Int J Cardiol 2016; 226:26-33. [PMID: 27780079 DOI: 10.1016/j.ijcard.2016.10.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is conflicting information regarding the association between hyperuricemia and survival in STEMI patients. Our study examined the interaction between hyperuricemia and Killip class on mortality of STEMI patients. METHODS We analyzed 951 consecutive STEMI patients between February 2006 and September 2012. Hyperuricemia was defined as SUA of at least 7mg/dL in males and 6mg/dL in females. Killip class I patients were divided into hyperuricemia and normouricemia groups. RESULTS The Killip class I hyperuricemia and normouricemia groups had similar baseline and procedural characteristics, but the hyperuricemia group had significantly greater BMI, serum creatinine, and SUA, and a lower TIMI risk score (2, IQR: 1-4 vs. 3, IQR: 2-4, p=0.019). The hyperuricemia group also had greater 30-day and 1-year mortality rates (2.9% vs. 0.3%, p=0.022; 6.5% vs. 1.1%, p=0.002, respectively). However, hyperuricemia was not associated with mortality of patients in Killip classes II-IV or in the overall study population. Hyperuricemia was associated with increased mortality in subgroups of patients who were at least 65years-old, male, had BMI of 25kg/m2 or less, were in Killip class I, without diabetes, and who did not receive intra-aortic balloon pump support. Hyperuricemia interacted with Killip class I in increasing the risk for 1-year mortality (p for interaction=0.038). CONCLUSIONS Hyperuricemia increased the 1-year mortality of STEMI patients in Killip class I, but not of patients in Killip classes II-IV. An interaction of hyperuricemia and Killip class significantly affects the mortality of STEMI patients.
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Affiliation(s)
- Cheng-Wei Liu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Internal Medicine, Tri-service General Hospital, Songshan Branch, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taiwan
| | - Pen-Chih Liao
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Chin Chen
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Wei Chiu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Computer Science & Engineering, Yuan Ze University, Taiwan
| | - Yuan-Hung Liu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shin-Rong Ke
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
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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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Javidi D, Ladan M, Vahdani A, Nazar A, Zarin Ara A, Alimohamadi Y. Weaning from IABP after CABG Surgery: Impact of Serum Lactate Levels as an Early Predictor. Int Cardiovasc Res J 2016. [DOI: 10.17795/icrj-10(03)135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sachdev A, Mehra B, Mohanty A, Gupta D, Gupta N. Refractory pediatric cardiogenic shock: A case for mechanical support. Indian J Crit Care Med 2016; 20:680-683. [PMID: 27994387 PMCID: PMC5144534 DOI: 10.4103/0972-5229.194012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute left ventricular dysfunction in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices, and the use of the intra-aortic balloon pump (IABP). The IABP is a commonly used method of temporary circulatory support in adults. However, despite the availability of pediatric size balloons, the usage of IABP for temporary circulatory support in children has not been widespread. Current case report, first from India in pediatric age group, aims to aware the pediatric intensivist about the role of IABP in providing temporary mechanical cardiovascular support in managing patients with refractory low cardiac output state.
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Affiliation(s)
- Anil Sachdev
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Bharat Mehra
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Mohanty
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dhiren Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
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Gelsomino S, Lozekoot PW, Lorusso R, de Jong MM, Parise O, Matteucci F, Lucà F, Kumar N, Dehkord ES, Romano SM, Gensini GF, La Meir M, Maessen JG. A New 35-mm Short Intra-aortic Balloon Catheter: A Suitable Option also for Non-Small-Sized Patients? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sandro Gelsomino
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
- Careggi Hospital, Florence, Italy
| | | | - Roberto Lorusso
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
| | | | - Orlando Parise
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
| | - Francesco Matteucci
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
| | - Fabiana Lucà
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
| | - Narendra Kumar
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
| | | | | | | | - Mark La Meir
- Maastricht University Medical Center, Maastricht, the Netherlands, Florence, Italy
- Department of Cardiothoracic Surgery, University Hospital, Brussels, Belgium
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Saura E, Savola J, Gunn J. A 6-Year Single-Center Experience of Intra-aortic Balloon Pump Treatment—Retrospective Analysis of 223 Patients. J Cardiothorac Vasc Anesth 2015; 29:1410-4. [DOI: 10.1053/j.jvca.2015.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Indexed: 11/11/2022]
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Swinney C, Itoh A, Keith A, Balsara K, Joseph S, Silvestry S. Defining the impact of intraaortic balloon pump setting on ventricular assist device flow. J Heart Lung Transplant 2015; 34:993-5. [PMID: 25935439 DOI: 10.1016/j.healun.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/06/2015] [Accepted: 03/16/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christian Swinney
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Akinobu Itoh
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Angela Keith
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Keki Balsara
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Joseph
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Scott Silvestry
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Kapelios CJ, Terrovitis JV, Nanas JN. Current and future applications of the intra-aortic balloon pump. Curr Opin Cardiol 2014; 29:258-65. [PMID: 24686399 DOI: 10.1097/hco.0000000000000059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The intra-aortic balloon pump (IABP) has been used for more than 40 years. Although recommended in a wide variety of clinical settings, most of these indications are not evidence-based. This review focuses on studies challenging these traditional indications and evaluates potentially new applications of intra-aortic counterpulsation. RECENT FINDINGS Recent studies have failed to confirm an improvement in clinical outcomes conferred by the IABP in patients developing cardiogenic shock after acute myocardial infarction. This issue is in need of further investigations. While conflicting results of several retrospective studies and meta-analyses have been published regarding the performance of the IABP in high-risk percutaneous coronary interventions, it has recently been found to improve the long-term clinical outcomes of patients in whom it was implanted before the procedure. Small, single-center studies have reported the use of the IABP as a bridge to transplantation or candidacy for left-ventricular assist device implantation. The recently reported feasibility and safety of its insertion via the subclavian or axillary arteries will facilitate these applications. SUMMARY The revisiting of available data and the performance of new, thoughtfully designed trials should clarify the proper indications for the IABP.
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Affiliation(s)
- Chris J Kapelios
- The 3rd Department of Cardiology, University of Athens School of Medicine, Athens, Greece
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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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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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Kapelios CJ, Terrovitis JV, Siskas P, Kontogiannis C, Repasos E, Nanas JN. Counterpulsation: a concept with a remarkable past, an established present and a challenging future. Int J Cardiol 2014; 172:318-25. [PMID: 24525157 DOI: 10.1016/j.ijcard.2014.01.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/19/2014] [Indexed: 01/24/2023]
Abstract
The intra-aortic balloon pump (IABP), which is the main representative of the counterpulsation technique, has been an invaluable tool in cardiologists' and cardiac surgeons' armamentarium for approximately half a century. The IABP confers a wide variety of vaguely understood effects on cardiac physiology and mechano-energetics. Although, the recommendations for its use are multiple, most are not substantially evidence-based. Indicatively, the results of recently performed prospective studies have put IABP's utility in the setting of post-infarction cardiogenic shock into question. However, the particular issue remains open to further research. IABP support in high-risk patients undergoing PCI is associated with favorable long-term clinical outcome. In cardiac surgery, the use of IABP in cases of peri-operative low-output syndrome, refractory angina or ischemia-related mechanical complications is a usual, but poorly justified strategy. Anecdotal cases of treatment of incessant ventricular arrhythmias, reversal of right ventricular dysfunction and partial myocardial recovery have also been reported with its use. Converging data demonstrate the potential of safe long-term IABP support as a bridge to decision making or a bridge to transplantation modality in patients with heart failure. The feasibility of IABP insertion via other than the femoral artery sites enhances this potential. Despite the fact that several other counterpulsation devices have been developed and tested overtime none has managed to substitute the IABP, which continues to be most frequently used mechanical assist device.
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Affiliation(s)
- Chris J Kapelios
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | - John V Terrovitis
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | - Panagiotis Siskas
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | | | - Evangelos Repasos
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | - John N Nanas
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece.
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Moon C. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients. Dimens Crit Care Nurs 2012; 31:223-7. [PMID: 22664876 DOI: 10.1097/dcc.0b013e318256d774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intra-aortic balloon pumping increases myocardial oxygen supply and decreases myocardial oxygen demand by inflation and deflation of the balloon. This leads to increased perfusion of the coronary arteries during diastole. This technology has been used for critically ill cardiac patients for more than 30 years. The literature suggests that preoperative use of an intra-aortic balloon pump can be effective in high-risk coronary artery bypass grafting patients. Preoperative benefits of this technology may yield positive outcomes in terms of hemodynamic effect, decreased length of stay in both the intensive care unit and the hospital, and the reduction of complications. However, the intra-aortic balloon pump must be used with a profound understanding of proper mechanism and function, monitoring, and observation for potential complications. This requires excellent critical care nursing management.
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Affiliation(s)
- Chooza Moon
- 4715 Sheboygan Ave, 327, Madison, WI 53705, USA.
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Mulholland J, Yarham G, Clements A, Morris C, Loja D. Mechanical left ventricular support using a 50 cc 8 Fr fibre-optic intra-aortic balloon technology: a case report. Perfusion 2012; 28:109-13. [DOI: 10.1177/0267659112454912] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: More than four decades have passed since the first clinical use of an (IABP) to improve the clinical scenario for patients with chronic left ventricular failure. The original IAB catheter size was 15 French (Fr), requiring an open surgical insertion and removal. This therapy has now become the most widely used mechanical device for failure of the left ventricle. The introduction of an 8 Fr fibre-optic IAB catheter with a 50 cc diastolic blood volume displacement has further increased the potential clinical impact of this technology. This new catheter can be used for all patients over 162 cm in height, allowing a broader spectrum of patients to benefit from increased diastolic blood volume displacement and fibre-optic pressure monitoring. The catheter has been designed on an 8 Fr shaft platform, potentially reducing the incidence of vascular complications. We present our case report on the world’s first implant of this 50cc 8 Fr IAB catheter. Case Report: Cardiac investigations on a 53-year-old man showed the patient to have ischaemic dilated cardiomyopathy with a left ventricular ejection fraction (LVEF) of 25%. An 8 Fr 50cc Sensation PlusTM IAB catheter was inserted pre-operatively, prior to coronary artery bypass grafting. Results: The world’s first insertion of this 8 Fr 50 cc IAB catheter was a complete success, with no complications. The patient’s pre-, peri- and post-operative courses were as we expected and event free, underpinned by IABP support. Conclusion: This new 50 cc, 8 Fr IAB expands the patient group that can benefit from greater diastolic blood volume delivery, improved distal perfusion, more accurate monitoring, subsequent better beat-per-beat support and, finally, the reduced complication rates associated with an 8 Fr shaft.
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Affiliation(s)
- J Mulholland
- Department of Clinical Perfusion Science, Essex Cardiothoracic Centre, Basildon, Essex, UK
- Honorary Member, Department of Clinical Perfusion Research, Imperial College Health Science Centre, London, UK
| | - G Yarham
- Department of Clinical Perfusion Science, Essex Cardiothoracic Centre, Basildon, Essex, UK
- Honorary Member, Department of Clinical Perfusion Research, Imperial College Health Science Centre, London, UK
| | - A Clements
- Department of Clinical Perfusion Science, Essex Cardiothoracic Centre, Basildon, Essex, UK
- Honorary Member, Department of Clinical Perfusion Research, Imperial College Health Science Centre, London, UK
| | - C Morris
- Department of Clinical Perfusion Science, Essex Cardiothoracic Centre, Basildon, Essex, UK
- Honorary Member, Department of Clinical Perfusion Research, Imperial College Health Science Centre, London, UK
| | - D Loja
- Department of Clinical Perfusion Science, Essex Cardiothoracic Centre, Basildon, Essex, UK
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Gelsomino S, Renzulli A, Rubino AS, Romano SM, Luca F, Valente S, Gensini GF, Lorusso R. Effects of 1:1, 1:2 or 1:3 intra-aortic balloon counterpulsation/heart support on coronary haemodynamics and cardiac contractile efficiency in an animal model of myocardial ischaemia/reperfusion. Eur J Cardiothorac Surg 2012; 42:325-332. [DOI: 10.1093/ejcts/ezr327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Jennings A, Norman A, Whitelock D, Haynes S, James G. Elective peri-operative intra-aortic balloon counterpulsation during maxillofacial free flap reconstructive surgery in a patient with severe cardiomyopathy. Anaesthesia 2010; 65:204-6. [DOI: 10.1111/j.1365-2044.2009.06182.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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