China
Africa
Explore chapters and articles related to this topic
Intraaortic Balloon Counterpulsation
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Minor complications of IABP counterpulsation include bleeding at the insertion site, superficial wound infections, lymphocele or seroma formation. These complications occur infrequently and are usually self-limited or resolve following IABP removal. Minor bleeding at the insertion site usually ceases following discontinuation of heparin sodium therapy and correction of the patient’s underlying coagulopathy. If it is felt that the patient would benefit from a low level of anticoagulation, balloon dependent patients who have not had or will not require CPB may be treated with low-molecular-weight dextran (10% dextran, 20 ml/hr IV).
The intra-aortic balloon pump: Principles and use
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Ventricular assistance using the IABP is often referred to as counterpulsation because, with proper timing, the balloon is deflated while the ventricle is contracting and inflated while the ventricle is in diastole, i.e. it cycles counter to the cardiac cycle. Counterpulsation relies on phasic displacement of blood, equal in volume to that of the inflated balloon, within a fixed intravascular space.1,5 Hence, balloon inflation improves myocardial oxygen delivery by an increase in coronary artery blood flow through augmentation of diastolic blood pressure, which increases coronary perfusion pressure. Balloon deflation decreases myocardial oxygen demand by lowering the aortic end-diastolic pressure (AEDP). This decreases afterload, which enables the left ventricle to deliver blood into the aorta at a lower pressure so that less work is performed to achieve ejection, as well as allowing an increase in SV.3,6,9,10,18
Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
Intra-aortic counterpulsation provides a minimally invasive method of support for failing left ventricular (LV) function by reducing afterload and improving myocardial oxygen supply–demand balance. However, the efficacy of counterpulsation depends on several factors, including intrinsic ventricular function. Counterpulsation therapy is produced by an intra-aortic balloon (IAB) and control system. The IABP consists of an inflatable balloon, which is placed in the aorta to improve cardiovascular functioning during certain life-threatening emergencies, and a control system for regulating the inflation and deflation of the balloon. The control system, which monitors and is synchronized with the electrocardiogram, provides a means for setting the inflation and deflation of the balloon with the cardiac cycle. The IABP provides counterpulsation therapy to adult patients with impaired LV function. The IAB is inserted via catheter into the femoral artery and positioned in the descending thoracic aorta 1–2 cm distal to the left subclavian artery. It provides hemodynamic support of blood pressure and reduced cardiac work through volume displacement principles.
Varying speed modulation of continuous-flow left ventricular assist device based on cardiovascular coupling numerical model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Hongtao Liu, Shuqin Liu, Xiaoxu Ma
There are still some controversies about the patterns of copulsation and counterpulsation. It has been reported that copulsation is easier to enhance the vascular pulsatility, and plays a role of training and stimulation on the heart by increasing ventricular load (Ando et al. 2011; Bozkurt, van Tuijl, et al. 2016; Naito et al. 2018). However, it has also been reported that counterpulsation is more likely to reduce the end-diastolic volume and ventricular work, which may be beneficial to the myocardial reverse remodeling (Umeki et al. 2012; Pirbodaghi et al. 2013; Bozkurt and Bozkurt 2017). Consequently, whether it be copulsation or counterpulsation, no consensus has been reached to produce the greatest hemodynamic benefit. In this study, we also demonstrate that copulsation can provide larger PP, and SHE, whereas counterpulsation can provide smaller LVEDV and LVEW.
The Rise of Endovascular Mechanical Circulatory Support Use for Cardiogenic Shock and High Risk Coronary Intervention: Considerations and Challenges
Published in Expert Review of Cardiovascular Therapy, 2021
Benjamin Schwartz, Pankaj Jain, Michael Salama, Navin K. Kapur
The distinct effects of IABP counterpulsation on patients with cardiogenic shock due to AMI versus advanced heart failure remain poorly understood. Given the primary effect on LV afterload, patients with high systemic vascular resistance and compliant aortic stiffness are more likely to respond. These factors may explain why IABP use in advanced HF patients appears to be associated with improved hemodynamics despite severely impaired native LV function. These observations may require further evaluation and testing in prospective studies. Furthermore, the proposed benefit of IABP on AMI patients is reliant on its ability to increase coronary perfusion pressure during diastolic balloon inflation and perhaps increased release of the vasoactive endothelial-derived nitric oxide through arterial stretch [6]. Similarly, high-risk PCI is a recent area of interest in the utility of IABP and similar mechanisms of benefit are thought to translate to this application. However, additional research is needed to understand true physiologic and clinical benefit.
Percutaneous temporary circulatory support devices and their use as a bridge to decision during acute decompensation of advanced heart failure
Published in Baylor University Medical Center Proceedings, 2018
The IABP, used for cardiogenic shock since 1968, is one of the oldest TMCS devices and has been the mainstay for hemodynamic support.10 More than 40,000 IABPs are used annually in the USA, and up to 19% of those are used in patients with cardiogenic shock.11 The IABP uses the concept of counterpulsation to help with the augmentation of diastolic aortic pressures and LV afterload reduction. It provides an approximately 20% increase in cardiac output with a 10% to 20% decrease in heart rate with an overall increase in myocardial oxygen supply.7 However, despite the stabilization of hemodynamics, the IABP has not shown the expected improvement in mortality.3 The cost of the device itself is relatively low (estimated $1500 to $2000). The average cost of hospitalization requiring IABP support was around $55,000 based on the national inpatient sample data from 2007 through 2012.12