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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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Grieshaber P, Schneider T, Oster L, Orhan C, Roth P, Niemann B, Böning A. Prophylactic intra-aortic balloon counterpulsation before surgical myocardial revascularization in patients with acute myocardial infarction. Perfusion 2018; 33:390-400. [DOI: 10.1177/0267659118760384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Prophylactic intra-aortic balloon counterpulsation (pIABC) is recommended for high-risk patients undergoing coronary artery bypass grafting (CABG) surgery. Criteria for high-risk patients benefiting from pIABC are unclear. This study aimed to specifically describe the effect of pIABC on outcomes of patients with acute myocardial infarction (AMI) undergoing CABG. Methods: In 178 of 484 AMI patients (non-ST-segment elevation myocardial infarction [NSTEMI] or ST-segment elevation myocardial infarction [STEMI] ≤5 days before surgery) without cardiogenic shock who underwent CABG between 2008 and 2013, pIABC was initiated preoperatively. After propensity score matching, the outcomes of 400 patients were analyzed (pIABC: 150; Control: 250). Results: After propensity score matching, baseline and operative characteristics were balanced between the groups except for a higher rate of patients with a left ventricular ejection fraction (LVEF)≤30% in the pIABC group (26% vs. Control: 13%; p=0.032). Seven point two percent (7.2%) of the control patients received an IABP intraoperatively or postoperatively. Postoperative extracorporeal life support (ECLS) was only needed in the control group (1.2% vs. 0%; p=0.01). Postoperative plasma curves of troponin I, creatine kinase (CK) and creatine kinase isoform MB (CK-MB) levels were reduced in the pIABC group compared with the control group. In-hospital mortality was reduced in the pIABC group (3.3% vs. control: 6.4%; p=0.18). After multivariate adjustment for other preoperative risk factors, pIABC was significantly protective concerning in-hospital mortality (HR 0.56; 95%-CI 0.023-0.74; p=0.021). Mortality (pIABC vs. control) was more affected in patients with preoperative LVEF≤30% (2/36 (5.6%) vs. 6/31 (19%); heart rate (HR) 0.25; 95%-CI 0.046-1.3; p=0.13) compared with LVEF>30% (3/114 (2.6%) vs. 10/219 (4.6%); HR 0.56; 95%-CI 0.15-2.1; p=0.55). Long-term survival did not differ between the groups. Conclusions: pIABC in CABG for AMI is associated with reduced perioperative cardiac injury and in-hospital mortality. Long-term survival is not affected.
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Affiliation(s)
- Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Tobias Schneider
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Lukas Oster
- Department of Anesthesiology, Sana Hospital Berlin-Lichtenberg, Berlin, Germany
| | - Coskun Orhan
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Peter Roth
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Bernd Niemann
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
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Romagnoli S, Franchi F, Ricci Z, Scolletta S, Payen D. The Pressure Recording Analytical Method (PRAM): Technical Concepts and Literature Review. J Cardiothorac Vasc Anesth 2017; 31:1460-1470. [DOI: 10.1053/j.jvca.2016.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 12/22/2022]
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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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Gelsomino S, Lozekoot PWJ, de Jong MMJ, Lucà F, Parise O, Matteucci F, Romano M, Hossien A, La Meir M, Marchionni N, Maessen JG, Lorusso R. Is visceral flow during intra-aortic balloon pumping size or volume dependent? Perfusion 2016; 32:285-295. [PMID: 27864477 DOI: 10.1177/0267659116678058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM We evaluated the influence of intra-aortic balloon size and volume on mesenteric and renal flows. METHODS Thirty healthy swine underwent 120-minute ligation of the left anterior descending coronary artery followed by 6 hours of reperfusion. Then, they were randomly assigned to the following five groups of animals, with six animals in each group: no intra-aortic balloon pump (IABP), a short 35-mL IABP, a short 40-mL IABP, a long 35-mL IABP and a long 40-mL IABP. Superior mesenteric artery (SMA) and renal flows were measured at baseline (t0), at 2-hour ischemia (t1) and every hour thereafter until 6 hours of reperfusion (from tR1 to tR6). RESULTS SMA flows increased significantly at tR1 only in the two short IABP groups (p<0.001) and balloon volume did not appear to affect flows which, at any experimental time-point, were comparable using 35 mL or 40 mL balloons (p>0.05). Renal flows appeared to be influenced by balloon length, but not by volume. Indeed, flows in the renal arteries rose during IABP treatment; the increase was significantly higher in the short balloon groups and throughout the whole reperfusion (all, p<0.001). CONCLUSIONS Changes in visceral perfusion during IABP assistance were significantly related to balloon length, but not to its volume. This could be relevant for the evolution of balloon engineering design in order to reduce the incidence of mesenteric ischemia following IABP. Further research is necessary to confirm these findings.
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Affiliation(s)
- Sandro Gelsomino
- 1 Maastricht University Medical Center, Maastricht, The Netherlands.,2 Department of Cardiothoracic and Vascular Medicine, Careggi Hospital and University of Florence, Italy
| | | | | | - Fabiana Lucà
- 1 Maastricht University Medical Center, Maastricht, The Netherlands
| | - Orlando Parise
- 1 Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Mario Romano
- 2 Department of Cardiothoracic and Vascular Medicine, Careggi Hospital and University of Florence, Italy
| | | | - Mark La Meir
- 1 Maastricht University Medical Center, Maastricht, The Netherlands
| | - Niccolò Marchionni
- 2 Department of Cardiothoracic and Vascular Medicine, Careggi Hospital and University of Florence, Italy
| | - Jos G Maessen
- 1 Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roberto Lorusso
- 1 Maastricht University Medical Center, Maastricht, The Netherlands
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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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Gelsomino S, Lozekoot PWJ, Lorusso R, de Jong MMJ, Parise O, Matteucci F, Lucà F, La Meir M, Gensini GF, Maessen JG. Comparing short versus standard-length balloon for intra-aortic counterpulsation: results from a porcine model of myocardial ischaemia-reperfusion. Eur J Cardiothorac Surg 2015; 49:1361-9. [PMID: 26646809 DOI: 10.1093/ejcts/ezv401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/10/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We compare a short and a standard-size balloon with same filling volumes to verify the differences in terms of visceral flow, coronary circulation and haemodynamic performance during aortic counterpulsation in an animal model of myocardial ischaemia-reperfusion injury. METHODS Eighteen healthy pigs underwent 120-min ligation of the left anterior descending coronary artery followed by 6 h of reperfusion, and they were randomly assigned to have intra-aortic balloon counterpulsation (IABP) with a 40-ml short-balloon (n = 6) or a 40-ml standard-length balloon (n = 6), or to undergo no IABP implantation (controls, n = 6). Haemodynamics and visceral and coronary flows were measured at baseline (t0), at 2 h of ischaemia (t1) and every hour thereafter until 6 h of reperfusion (from tR1 to tR6), respectively. RESULTS Mesenteric flows increased significantly at tR1 only in the short-balloon group (P < 0.001) and it was constantly higher than in the standard-balloon group regardless of mean arterial pressure, systemic vascular resistance and cardiac output (CO; all, P < 0.001). Renal blood flows were significantly increased during IABP treatment with values constantly and significantly higher in short balloons at any following experimental step (all, P < 0.05). IABP improved CO and coronary blood flow, and reduced afterload, myocardial resistances and myocardial oxygen consumption without differences between the short and the standard-length balloon (all, P > 0.05). CONCLUSIONS The short balloon prevents visceral ischaemia and, compared with the standard-size balloon, it does not lose IABP beneficial cardiac and coronary-related effects. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Sandro Gelsomino
- Maastricht University Medical Center, Maastricht, Netherlands Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, Maastricht, Netherlands Careggi University Hospital, Florence, Italy
| | | | - Roberto Lorusso
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Orlando Parise
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Fabiana Lucà
- Maastricht University Medical Center, Maastricht, Netherlands Careggi University Hospital, Florence, Italy
| | - Mark La Meir
- Maastricht University Medical Center, Maastricht, Netherlands Department of Cardiothoracic Surgery, University Hospital, Brussels, Belgium
| | | | - Jos G Maessen
- Maastricht University Medical Center, Maastricht, Netherlands
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Gelsomino S, Lozekoot PW, Lorusso R, de Jong MM, Parise O, Matteucci F, Lucà F, La Meir M, Gensini GF, Maessen JG. Short intra-aortic balloon pump in a swine model of myocardial ischaemia: a proof-of-concept study. Eur J Cardiothorac Surg 2015; 49:901-9. [DOI: 10.1093/ejcts/ezv271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/30/2015] [Indexed: 11/12/2022] Open
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Assessment of left ventricular function by pulse wave analysis in critically ill patients. Intensive Care Med 2013; 39:1025-33. [PMID: 23474659 DOI: 10.1007/s00134-013-2861-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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