A Randomized Trial of Pulsatile Perfusion Using an Intra-Aortic Balloon Pump Versus Nonpulsatile Perfusion on Short-Term Changes in Kidney Function During Cardiopulmonary Bypass During Myocardial Reperfusion

“Flow and Rate”: Concept and Clinical Applications of a New Hemodynamic Theory

“…This may be explained by pulsatile CPB inadequate curves with the necessity of a double perfusion pumps system to compensate the oxygenators momentum energy losses. Instead associating an intra-aortic balloon pump (IABP) with a conventional CPB, as a cost-effective manner (Onorati, et al, 2007), creates turbulent zones of vortices (Geankoplis, 2005), with vascular complications (Sanfelippo, et al,1987) and controversial effectiveness ( Kadoi Y & Saito, 2000).…”

Acute Kidney Injury After Cardiovascular Surgery: An Overview

“…the use of automatic pulsatile intra-aortic balloon pumps during cardiopulmonary bypass has been associated with better kidney function. 38 off-pump coronary artery bypass may be associated with a lower incidence of postoperative aki but did not affect the need for dialysis. 39,40 in a randomized, single-blind, controlled pilot trial of 120 adult patients undergoing cardiopulmonary bypass, remote ischemic preconditioning resulted in a 27% absolute risk reduction of aki.…”

Pulsatile Cardiopulmonary Bypass With Intra-Aortic Balloon Pump Improves Organ Function and Reduces Endothelial Activation

“…All patients were scheduled for preoperative IABP because of cardiac indications, as already reported, 8 and were also considered at risk for a preoperative ischemic event, which included any of the following: critical left main disease with occlusion ≥90% ± poor left ventricular ejection fraction (LVEF <40%); severe left mainstem lesion ≥75% with severe right coronary stenosis ≥90%; severe depression of the LVEF (<25%) regardless of the severity of any of the coronary lesions. Patients were randomized by lottery, drawing out pre-prepared sealed envelopes containing the group assignment: 270 patients (Group A) received preoperative IABP treatment before induction of anesthesia, with IABP turned off during cardioplegic arrest, and restarted with a 1:1 IABP mode immediately after cross-clamp removal, following the traditional standard of care; the other 231 patients (Group B) received preoperative IABP, as described earlier, which was then switched to an automatic 80 beats/min mode during cross-clamping (in order to achieve pulsatile flow during aortic cross-clamping) and switched again to a 1:1 IABP mode after cross-clamp removal.…”

“…Patients were randomized by lottery, drawing out pre-prepared sealed envelopes containing the group assignment: 270 patients (Group A) received preoperative IABP treatment before induction of anesthesia, with IABP turned off during cardioplegic arrest, and restarted with a 1:1 IABP mode immediately after cross-clamp removal, following the traditional standard of care; the other 231 patients (Group B) received preoperative IABP, as described earlier, which was then switched to an automatic 80 beats/min mode during cross-clamping (in order to achieve pulsatile flow during aortic cross-clamping) and switched again to a 1:1 IABP mode after cross-clamp removal. 8 Institutional Review Board/Ethics Committee approval was obtained (September 2003). Informed consent was given by each patient.…”

“…8 The need for a further increase in inotropes was established in order to maintain mean arterial pressure >65 mmHg with a central SvO2 >60%, after optimization of the preload. 8 Inotropic support was recorded and defined as "low-dose" when enoximone was administered at ≤5 μg · kg -1 · min -1 ; "medium-dose" when enoximone was between 6 and 10 μg · kg -1 · min -1 , or dobutamine was added at a dosage between 5 and 10 μg · kg -1 · min -1 ; or "high-dose" when enoximone or dobutamine infusion was >10 μg · kg -1 · min -1 or epinephrine at any dose was added. 8…”