Original articleCardiovascularBeat-to-Beat Effects of Intraaortic Balloon Pump Timing on Left Ventricular Performance in Patients With Low Ejection Fraction
Section snippets
Patients
Fifteen patients, New York Heart Association (NYHA) class II–IV, 48 to 64 years old, EF 21.5% ± 8.5%, undergoing cardiac surgery requiring prophylactic IABP, were studied. Eight patients underwent LV aneurysmectomy (6 patients with coronary artery bypass graft [CABG]), 6 patients underwent CABG (1 with mitral valve repair), and 1 patient underwent mitral valve repair. Open chest hemodynamic evaluations of acute effects of IABP were performed before cardiopulmonary bypass.
The study protocol was
Hemodynamic Response to Conventionally Timed IABP
The acute effects of proper IABP timing at a 1:1 assist ratio are illustrated by two typical examples (Fig 1). The largest decreases in LV pressure, LV end-systolic volume (ESV), LV end-diastolic volume (EDV) and concomitant increases in SV are observed within 4 assisted beats. Decreases in LVESV and LV end-systolic pressure (ESP) delineate the end-systolic P-V relationship and its slope, the Ees, representing a load independent index of contractile state. The average hemodynamic responses to
Comment
This study demonstrates acute beneficial effects of properly timed IABP at a 1:1 ratio in heart failure patients. Decreases in aortic impedance resulted in instantaneous increases in SV by LV afterload reduction with concomitant decreases in LVESV, LVEDV, and LV mechanical dyssynchrony. The decreases in LVESV and LVESP delineated the slope (Ees) of the end-systolic P-V relationship. The largest increases in SV occurred in the patients with the lowest contractile state.
Premature IAB inflation
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2022, Cardiovascular Revascularization MedicineCitation Excerpt :Collectively, hemodynamic effects with iVAC2L were more pronounced than what could be achieved with IABP in prior studies. IABP had only a modest impact in 15 heart failure patients undergoing cardiac surgery and in a subset of patients with advanced heart failure which was characterized by low right heart filling pressures and high systemic vascular resistance [5,6]. Our results suggest that iVAC2L generates more LV unloading by means of enhanced reductions in filling pressures and volumes.
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