Left Intraventricular Balloon Pump Optimization during Intractable Cardiac Arrest

Stamatelopoulos, Stamatios; Kochilas, Lazaros; Saridakis, Nikolaos; Zakopoulos, Nikos; Moulopoulos, Spyridon D.

doi:10.1177/039139889601900708

Cited by 6 publications

(17 citation statements)

References 5 publications

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“…Previous IVBP studies have tested flexible balloons for LV implantation in animal models with different volumes (from 40 to 110 mL) and geometries, such as: spherical, tomato, pear, and an LV cast at end-diastole. 6,8,10,12,13 Interestingly, only 1 study has customized the balloon volume to the LV shape: Stamatelopoulos et al evaluated 3 balloon volumes (LVEDV and LVEDV ± 25%) on IVBP function. 13 Results indicated that an intraventricular balloon volume equal to the corresponding LVEDV generated the largest MAP and AoF.…”

Section: Discussionmentioning

confidence: 99%

“…6,8,10,12,13 Interestingly, only 1 study has customized the balloon volume to the LV shape: Stamatelopoulos et al evaluated 3 balloon volumes (LVEDV and LVEDV ± 25%) on IVBP function. 13 Results indicated that an intraventricular balloon volume equal to the corresponding LVEDV generated the largest MAP and AoF. To the best of our knowledge, there are no IVBP studies that aimed to prevent mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 The authors suspect that in previous studies, the balloon inflation inside the LV distorted the papillary muscles leading to an increase in mitral regurgitation. 6,7,10,13 This suspicion was the motivation of this study to perform an anatomical fitting, endeavoring to maximize the balloon volume without interactions with the papillary muscle and chordae. With this design, it is expected that the balloon will support patient hemodynamics without displacing the papillary muscles and chordae and subsequently reduce the prevalence of mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Although early in vivo studies indicated the potential of IVBPs to provide partial support, benefits were commonly limited by signs of mitral regurgitation. 6,10,13 Mitral regurgitation may lead to a worsening of heart failure, atrial fibrillation, and pulmonary hypertension-potentially caused by abnormal displacement of papillary muscles that impedes leaflet coaptation. 15,16 Stamatelopoulos et al hypothesized that balloon inflation inside the LV could compress and distort the papillary muscles leading to increased mitral regurgitation.…”

mentioning

confidence: 99%

“…15,16 Stamatelopoulos et al hypothesized that balloon inflation inside the LV could compress and distort the papillary muscles leading to increased mitral regurgitation. 13 Nevertheless, previous IVBP functions were evaluated with generic balloon shapes without consideration for the papillary muscles. 5,6 Previous IVBP studies evaluated the IVBP function with a single actuation timing: balloon inflation during systole and deflation during diastole.…”

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confidence: 99%

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Evaluation of an intraventricular balloon pump for short‐term support of patients with heart failure

Boone

Gregory

et al. 2019

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The high cost of ventricular assist devices results in poor cost‐effectiveness when used as a short‐term bridging solution, thus a low‐cost alternative is desirable. The present study aimed to develop an intraventricular balloon pump (IVBP) for short‐term circulatory support, and to evaluate the effect of balloon actuation timing on the degree of cardiac support provided to a simulated in vitro severe heart failure (SHF) patient. A silicone IVBP was designed to avoid contact with internal left ventricular (LV) features (ie, papillary muscles, chordae, aortic, and mitral valves) based on LV computed tomography data of 10 SHF patients with dilated cardiomyopathy. The hemodynamic effects of varying balloon inflation and deflation timing parameters (inflation duty [D] and end‐inflation point [σ]) were evaluated in a purpose‐built systemic mock circulatory loop. Three IVBP actuation timing categories were defined: co‐, transitional, and counterpulsation. Compared to the SHF baseline, co‐pulsation increased aortic flow from 3.5 to 5.2 L/min, mean arterial pressure from 72.1 to 94.8 mmHg and ejection fraction from 14.4% to 21.5%, while mean left atrial pressure decreased from 14.6 to 10 mmHg. Transitional and counterpulsation resulted in a double ventricular pulse and extended the duration of increased ventricular pressure, potentially impeding diastolic filling and coronary perfusion. This in vitro study showed the IVBP could restore the hemodynamic balance of a simulated SHF patient with dilated cardiomyopathy to healthy levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of an intraventricular balloon pump for short‐term support of patients with heart failure

Boone

Gregory

et al. 2019

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Ventricular Flow Dynamics With an Intra-Ventricular Balloon Pump: An In Vitro Analysis

et al. 2022

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Due to the high treatment costs associated with durable ventricular assist devices, an intra-ventricular balloon pump (IVBP) was developed to provide low-cost, short-term support for patients suffering from severe heart failure. It is imperative that intraventricular flow dynamics are evaluated with an IVBP to ensure stagnation points, and potential regions for thrombus formation, are avoided. This study used particle image velocimetry to evaluate flow patterns within the left ventricle of a simulated severe heart failure patient with IVBP support to assess left ventricle pulsatility as an indicator of the likelihood of flow stasis. Two inflation timings were evaluated against the baseline severe heart failure condition: IVBP co-pulsation and IVBP counter-pulsation with respect to ventricular systole. IVBP co-pulsation was found to have a reduced velocity range compared to the severe heart failure condition (0.44 m/s compared to 0.54 m/s). IVBP co-pulsation demonstrated an increase in peak velocities (0.25 m/s directed toward the aortic valve during systole, as opposed to 0.2 m/s in severe heart failure), indicating constructive energy in systole and cardiac output (1.7 L/min increase with respect to severe heart failure baseline -3.5 L/min) throughout the cardiac cycle. IVBP counter-pulsation, while exhibiting the greatest peak systolic velocity directed to the aortic valve (0.4 m/s) was found to counterasct the natural vortex flow pattern during ventricular filling, as well as inducing a secondary ventricular pulse during diastole and a 23% increase in left ventricle end-diastolic volume (indicative of dilation). Ideal IVBP actuation timing did not result in reduced intraventricular pulsatility, indicating promising blood washout. ASAIO

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Proof of principle of a novel co‐pulsating intra‐ventricular membrane pump

et al. 2020

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BACKGROUND During cardiogenic shock (CS) coronary perfusion is compromised, causing a further reduction in cardiac output (CO). 1 The compromised hemodynamic state leads to a cascade of pro-inflammatory cytokine release, multiple organ failure, and eventually death. To avert the downward spiral of CS, short-term mechanical support devices have been used. 2 Despite a plethora of mechanical support devices, CS continues to have a very poor outcome with a reported mortality rate as high as 50%. 3-5 All currently available support devices deliver a nonphysiological flow, which potentially limits their efficacy. The Impella (Abiomed; Danvers, MA, USA) delivers an antegrade continuous flow, while pulsatile flow may have positive effects on organ perfusion, especially in the early phase of shock. 6-9 The intra-aortic balloon pump (IABP) uses counter-pulsatile support with passive unloading, with

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Left Intraventricular Balloon Pump Optimization during Intractable Cardiac Arrest

Cited by 6 publications

References 5 publications

Evaluation of an intraventricular balloon pump for short‐term support of patients with heart failure

Evaluation of an intraventricular balloon pump for short‐term support of patients with heart failure

Ventricular Flow Dynamics With an Intra-Ventricular Balloon Pump: An In Vitro Analysis

Proof of principle of a novel co‐pulsating intra‐ventricular membrane pump

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