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Inglis SS, Kanwar A, Bonilla HG, Singh S, Pearson JY, Abbas M, Folkens LA, Ou NN, Spencer PJ, Villavicencio MA, Clavell AL, Frantz RP, Rosenbaum AN, Behfar A. Reduction in Balloon Pump Size Reduces Axillary Intraaortic Balloon Pump Failure Risk. ASAIO J 2024:00002480-990000000-00521. [PMID: 38976860 DOI: 10.1097/mat.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Axillary artery intra-aortic balloon pump (axIABP) placement has been implemented as a bridging solution before heart transplantation. This study evaluates complications associated with axIABP support and describes an approach to minimize adverse events. We previously described a percutaneous approach for axIABP placement. However, patients receiving axIABP between September 1, 2017, and September 26, 2019 (n = 32) demonstrated a high rate of balloon pump malfunction (8/32; 25%) and other complications (totaling 15/32; 47%). Sixty-four patients were sequentially treated under a revised protocol. Compared to the initial cohort, no significant differences in demographics were noted. A significant reduction in rate of balloon malfunction (8/32, 25% vs. 1/64, 2%; p < 0.001) and total complications (15/32, 47% vs. 10/64, 16%; p = 0.0025) during the period of support were noted after intervention. Subsequent analysis of total complications per device size (40 vs. ≤ 34 ml balloon) revealed significantly reduced complications in patients with smaller devices (40% vs. 13%, respectively; p = 0.0022). This study provides guidelines to limit complications in patients supported with axIABP, facilitating a protracted period of bridging support.
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Affiliation(s)
- Sara S Inglis
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ardaas Kanwar
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
| | | | - Swaiman Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohsin Abbas
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
| | - Lori A Folkens
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Narith N Ou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Department of Pharmacy Operations, Rochester, Minnesota
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Alfredo L Clavell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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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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Vondran M, Rastan AJ, Tillmann E, Seeburger J, Schröter T, Dhein S, Bakhtiary F, Mohr FW. Intra-Aortic Balloon Pump Malposition Reduces Visceral Artery Perfusion in an Acute Animal Model. Artif Organs 2015; 40:334-40. [PMID: 26366459 DOI: 10.1111/aor.12563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Visceral artery perfusion can be potentially affected by intra-aortic balloon pump (IABP) catheters. We utilized an animal model to quantify the acute impact of a low balloon position on mesenteric artery perfusion. In six pigs (78 ± 7 kg), a 30-cc IABP was placed in the descending aorta in a transfemoral procedure. The celiac artery (CA) and the cranial mesenteric artery (CMA) were surgically dissected. Transit time blood flow was measured for (i) baseline, (ii) 1:1 augmentation with the balloon proximal to the visceral arteries, and (iii) 1:1 augmentation with the balloon covering the visceral arteries. Blood flow in the CMA and CA was reduced by 17 and 24%, respectively, when the balloon compromised visceral arteries compared with a position above the visceral arteries (flow in mL/min: CMA: (i) 1281 ± 512, (ii) 1389 ± 287, (iii) 1064 ± 276, P < 0.05 for 3 vs. 1 and 3 vs. 2; CA: (i) 885 ± 370, (ii) 819 ± 297, (iii) 673 ± 315; P < 0.05 for 3 vs. 1). The covering of visceral arteries by an IABP balloon causes a significant reduction of visceral artery perfusion; thus, the positioning of this device during implantation is critical for obtaining a satisfactory outcome.
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Affiliation(s)
- Maximilian Vondran
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Ardawan J Rastan
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Eugen Tillmann
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Seeburger
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Schröter
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Stefan Dhein
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Wong GKC, Teoh J, Chan EKY, Ng SCP, Poon WS. Intracranial aneurysm size responsible for spontaneous subarachnoid haemorrhage. Br J Neurosurg 2012; 27:34-9. [DOI: 10.3109/02688697.2012.709559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Parissis H, Soo A, Leotsinidis M, Dougenis D. A statistical model that predicts the length from the left subclavian artery to the celiac axis; towards accurate intra aortic balloon sizing. J Cardiothorac Surg 2011; 6:95. [PMID: 21827666 PMCID: PMC3169457 DOI: 10.1186/1749-8090-6-95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ideally the length of the Intraaortic balloon membrane (22-27.5 cm) should match to the distance from the left subclavian artery (LSA) to the celiac axis (CA), (LSA - CA). By being able to estimate this distance, better guidance regarding IABP sizing could be recommended. METHODS Internal aortic lengths and demographic values were collected from a series of 40 cadavers during autopsy. External somatometric measurements were also obtained.There were 23 males and 17 females. The mean age was 73.1+/-13.11 years, weight 56.75+/-12.51 kg and the height 166+/-9.81 cm. RESULTS Multiple regression analysis revealed the following predictor variables (R2 > 0.70) for estimating the length from LSA to CA: height (standardized coefficient (SRC) = 0.37, p = 0.004), age (SRC = 0.35, p < 0.001), sex (SRC = 0.21, p = 0.088) and the distance from the jugular notch to trans-pyloric plane (SRC = 0.61, p < 0.001). RECOMMENDATIONS If LSA-CA < 21.9 cm use 34 cc IABP & if LSA-CA > 26.3 cm use 50 cc IABP. However if LSA-CA = 21.9- 26.3 cm use 40 cc, but be aware that it could be "aortic length-balloon membrane length" mismatching. CONCLUSIONS Routinely, IABP size selection is being dictated by the patient's height. Inevitably, this leads to pitfalls. We reported a mathematical model of accurate intraaortic balloon sizing, which is easy to be applied and has a high predictive value.
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Affiliation(s)
- Haralabos Parissis
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, BT12 6BA, UK & Northern Ireland.
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Rastan AJ, Tillmann E, Subramanian S, Lehmkuhl L, Funkat AK, Leontyev S, Doenst T, Walther T, Gutberlet M, Mohr FW. Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation 2010; 122:S92-9. [PMID: 20837932 DOI: 10.1161/circulationaha.109.929810] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition. METHODS AND RESULTS From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0%) received perioperative IABP support, of whom 63 (10.1%) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3% were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8% but only appropriate in 38.1% based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8%; superior mesenteric artery, 87.3%; and renal arteries, 66.7%. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2%. Spinal deformations were found in 42.9%. Laparotomy for mesenteric ischemia was required in 23.8%. Hospital mortality rate was 60.3%. CONCLUSIONS IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.
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Affiliation(s)
- Ardawan Julian Rastan
- University of Leipzig, Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
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Vondran M, Tillmann E, Lehmkuhl L, Funkat A, Leontyev S, Doenst T, Schröter T, Gutberlet M, Mohr F, Rastan A. Kompromittierung der Viszeralarterien nach Einlage einer intraaortalen Ballonpumpe. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2010. [DOI: 10.1007/s00398-010-0796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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