Counterpulsation: Historical Background, Technical Improvements, Hemodynamic and Metabolic Effects

Abstract

The intraaortic balloon counterpulsation is performed today on the same principles that were described in its first experimental use in 1962. Experimental studies have shown significant increase of the mean aortic diastolic pressure, the diastolic pressure-time index, endocardial viability ratio, cardiac output, ejection fraction, coronary cerebral and renal blood flow, lactate utilization and myocardial oxygen supply and significant decrease of the systolic aortic pressure, left-ventricular end-diastolic pressure, left-ventricular work, tension time index, myocardial oxygen consumption and lactate production. In similar studies, intraaortic balloon pump (IABP) decreases the size of myocardial infarction. New IABP driving systems, small size sheaths and balloon catheters for percutaneous insertion made the use of the IABP easier and safer. The paraaortic counterpulsation device is suitable for chronic mechanical assistance. It is more effective than the IABP and shows excellent biocompatibility in chronic experiments. Its clinical application in 3 patients showed excellent biocompatibility and promising hemodynamic effects. In conclusion, the salutary hemodynamic effects of the IABP have been shown in several experimental studies. The technical improvements and the development and use of new devices suggest that we still need to learn more about the usefulness of the counterpulsation technique.

Feasibility of subcutaneous ECG leads for synchronized timing of a counterpulsation device.

“…Counterpulsation therapy increases the diastolic aortic pressure by 30-70% improving end-organ perfusion and coronary perfusion [12][13][14]. The ejection pressure of the native ventricle is diminished, reducing afterload and left ventricular external work [12,[15][16][17][18].…”

“…The ejection pressure of the native ventricle is diminished, reducing afterload and left ventricular external work [12,[15][16][17][18].…”

“…The peak systolic pressure is reduced by up to 15% [12,16,17], while the end diastolic pressure is decreased by up to 30% [12,16,17]. Cardiac output and stroke volume have been found to increase by up to 20% [13,19].…”

“…Each year more than 160,000 patients worldwide receive IABP therapy and, as a result, clinicians have developed a great deal of confidence in the therapeutic effectiveness of IABP counterpulsation [12,15]. Placement of an IABP simply requires percutaneous access to the femoral artery.…”

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