Dynamic abdominal and thoracic aortomyoplasty in heart failure: assessment of counterpulsation

Fischer, Edmundo Cabrera; Christen, Alejandra; Forteza, Eduardo de; Risk, Marcelo

doi:10.1016/s0003-4975(99)00159-9

Cited by 16 publications

(4 citation statements)

References 17 publications

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“…30 During diastole, IABP inflation raises central aortic mean diastolic pressure and lowers central aortic end-diastolic pressure. 31 The result of these combined effects is a normalization of the myocardial oxygen demand/supply ratio [32][33][34][35] (Figures 1 and 2). IABP effects may be enhanced by improved coronary blood flow, due to increased diastolic perfusion gradient.…”

Section: Hemodynamics and Energetics Of Intra-aortic Balloon Pump Cou...mentioning

confidence: 99%

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

Baldetti

Pagnesi

Gramegna

et al. 2021

Circ: Heart Failure

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Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure–related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.

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Section: Hemodynamics and Energetics Of Intra-aortic Balloon Pump Cou...mentioning

confidence: 99%

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

Baldetti

Pagnesi

Gramegna

et al. 2021

Circ: Heart Failure

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“…Circulatory assistance obtained with this new technique was shown to be capable of restoring hemodynamic parameters in this acute animal model of heart failure. Moreover, the extent of diastolic pressure augmentations, evaluated through DABAC/SABAC index (8), showed significant increase compared with unassisted values.…”

Section: Discussionmentioning

confidence: 87%

“…Consequently, we focused our attention on the study of the aortic wall pressure‐diameter relationship behavior along the cardiac cycle during a certain period of time with a ratio 1:1 with heart rate. We previously estimated that aortic wall viscoelastic properties could vary because systemic vascular resistance values usually decrease using aortic counterpulsation with a ratio 1:2 with heart rate during periods shorter than 3 min (8). The increase of the viscosity index (Eta) suggests an increase of arterial wall energy loss, and the decrease of the stiffness index (Beta) would imply that aortic compliance might be improved due to aortic counterpulsation; these effects on aortic wall were not confirmed as large standard deviation values were obtained, but they are consistent with a previous report (16).…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac output and mean pressures were used to obtain systemic vascular resistance and cardiac index values. The extent of the diastolic aortic augmentation was measured by the counterpulsation index derived from the diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) previously described (8). In all cases, the DABAC/SABAC counterpulsation index was calculated through a program specifically developed in C++ language in our laboratory.…”

Section: Methodsmentioning

confidence: 99%

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A New Approach to Assist Postoperative Heart Failure in an Animal Model: Juxta‐Aortic Counterpulsation

et al. 2002

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Aortic counterpulsation is a useful technique frequently used in postcardiotomy heart failure. An acute heart failure model in open chest sheep was chosen to evaluate hemodynamic improvement with a counterpulsation balloon pump in juxta‐aortic position. This was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the aorta. Juxta‐aortic balloon pump counterpulsation in acute experimental heart failure resulted in a significant improvement of hemodynamic parameters: increase of cardiac output (from 0.86 ± 0.04 to 1.29 ± 0.09 L/min, p < 0.05) and cardiac index (from 0.03 ± 0.01 to 0.04 ± 0.01 L/min per kg, p < 0.05), and decrease of systemic vascular resistance (from 89.76 ± 6.69 to 66.56 ± 6.02 mm Hg/L per min, p < 0.05). The extent of aortic diastolic pressure change evaluated through the diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index before cardiac failure induction showed a significant increase compared with unassisted values (from 0.81 ± 0.10 to 1.12 ± 0.09, p < 0.05). Assisted values of DABAC/SABAC index after heart failure induction also showed a significant increase compared with unassisted values (from 0.78 ± 0.21 to 1.17 ± 0.38, p < 0.05). Treatment of experimental acute heart failure by juxta‐aortic balloon pump counterpulsation allows an effective hemodynamic improvement in open chest sheep.

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Intra-aortic balloon pumping reduces the increased arterial load caused by acute cardiac depression, modifying central and peripheral load determinants in a time- and flow-related way

2011

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The mechanisms that explain intra-aortic balloon pumping (IABP) effects are not completely understood, and attributing them only to pressure-associated changes in cardiac function would be an oversimplification. Since IABP modifies the aortic and systemic blood-flow pattern, flow-related effects could be expected. To characterize effects of acute heart failure (AHF) on the arterial biomechanics; IABP effects on the arterial biomechanics during AHF, and their potential time-dependence; the association between hemodynamics and biomechanical changes during AHF and IABP. Sheep (n = 6) aortic pressure, flow, and diameter were measured: (1) before (Basal) and (2) 1-3 (HF(1-3)) and 28-30 (HF(28-30)) min after starting halothane to induce AHF; and (3) at specific times (1-3, 14-15 and 28-30 min) during IABP assistance. Calculus: aortic characteristic impedance (Z(c)), beta stiffness (β), incremental (E(INC)) and pressure-strain elastic modulus (E(P)); total arterial compliance (C(G)), total systemic vascular resistance and wave propagation parameters. (1) AHF resulted in an acute increase in aortic and systemic stiffness (HF(28-30) % changes with respect to Basal conditions: β +217%, E (P) +143%, E(INC) +101%, Z(c) +52%, C(G) -13%), associated with the reduction in the aortic blood flow; (2) during AHF IABP resulted in acute beneficial changes aortic and systemic biomechanics (% changes in IABP(1-3) with respect HF(28-30): β -62%, E(P) -68%, E (INC) -66%, Z(c) -38%, C(G) 66%), and in wave propagation parameters, (3) IABP-related changes were time-dependent and associated with changes in aortic blood flow. Aortic and systemic biomechanical and impedance properties are detrimentally modified during AHF, being the changes rapidly reverted during IABP. IABP-related beneficial changes in arterial biomechanics were time-dependent and associated with IABP capability to increase blood flow.

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Dynamic abdominal and thoracic aortomyoplasty in heart failure: assessment of counterpulsation

Cited by 16 publications

References 17 publications

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

A New Approach to Assist Postoperative Heart Failure in an Animal Model: Juxta‐Aortic Counterpulsation

Intra-aortic balloon pumping reduces the increased arterial load caused by acute cardiac depression, modifying central and peripheral load determinants in a time- and flow-related way

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