Intra-aortic balloon pumping increases renal blood flow in patients with low left ventricular ejection fraction

Abstract

Intra-aortic balloon pumping (IABP) has, for decades, been one of the key treatment modalities following impaired cardiac function after cardiac surgery. IABP increases cardiac output, decreases oxygen consumption of the heart and relieves the left ventricle. However, a number of complications have been reported in connection with IABP treatment. Only a few studies have evaluated renal blood flow and the purpose of this prospective study was to evaluate whether renal blood flow was affected by IABP treatment in high-risk patients. After approval from the county ethical committee and informed consent, seven consecutive patients with low left ventricular ejection fraction and scheduled for preoperative IABP treatment were allocated to the study. Assessment of renal blood flow was based on ultrasound spectral Doppler estimation of the flow velocity profiles in the interlobar kidney arteries. The result was described as balloon index (BI), which is maximal systolic velocity divided by the temporal mean velocity. Typical velocity profiles were demonstrated in all patients before, during and after IABP. BI measurement changed with time (p <0.05). BI was lower during IABP compared to both pre-IABP and post-IABP (p <0.025), indicating a higher renal blood flow. No statistically significant changes were seen in s-creatinine or creatinine clearance. Assuming unchanged diameter of kidney arteries and no considerable decrease in renal resistance and/or compliance, we conclude that the interlobar renal blood flow was significantly increased during IABP treatment, measured by ultrasound Doppler technique, but without a simultaneously significant change in creatinine clearance.

Superior mesenteric and renal flow patterns during intra‐aortic counterpulsation

“…Moreover, we confirmed that IABP increased renal flow (Sloth et al., ), and this improvement occurred without any difference between the right and left kidneys despite their different anatomical features. However, it is known that there are no differences in diameter or distances to branching between the right and left renal arteries (Tarzamni et al., ).…”

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

“…This is an interesting clinical observation that received less attention in previous reports about IABP in non-ischaemic CS. One study on ultrasound spectral Doppler estimation of renal flow velocity reported higher renal blood flow during IABP support [22]. Although we did not routinely perform haemodynamic measurements in the present study, we hypothesize that the decrease in LV afterload by IABP increases right to left flow and leads to decreased right-sided congestion and increased renal perfusion, which result in enhanced diuresis.…”

Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys — An experimental porcine model of ischaemic heart failure

“…In agreement with this, a non-significant higher blood flow in the carotid artery was observed during combined support compared to the Impella® device alone. Only a few studies have investigated the effect of IABP on renal blood flow with conflicting results, demonstrating both increased and unchanged renal blood flow during IABP support [22,23]. However, whether the higher blood flow during Impella® support was associated with an improved kidney function is unknown.…”