Abstract 17192: Counterpulsation Requires Pulsation: Acute Hemodynamic Effects of Large Capacity Intra-aortic Balloon Counterpulsation Pumps in Patients With Advanced Heart Failure
Introduction: Large (50cc) intra-aortic balloon counterpulsation pumps (IABPs) are commonly used in advanced heart failure (AHF). Few studies have examined the hemodynamic efficacy of IABPs in AHF. We hypothesized that the hemodynamic effect of IABPs correlates directly with native cardiac function in patients with AHF.
Methods: We prospectively studied 10 consecutive patients with Stage D AHF referred for non-emergent 50cc IABP placement prior to LVAD (left ventricular assist device) surgery. 5 control subjects had preserved left ventricular (LV) ejection fraction (EF) and did not receive IABP therapy. Hemodynamics were recorded using LV conductance and pulmonary artery catheters within 15 minutes before and after IABP activation. IABP Responders were defined by a >20% increase in cardiac index (CI) within 24 hours after IABP activation.
Results: Mean LVEF was 10±4 among AHF patients (p < 0.01). AHF patients had lower LV stroke work, higher LV pressures and volumes before IABP activation (Figure A). Pairwise analysis showed that IABP activation reduced LV stroke work primarily by reducing end-systolic pressure, not end-diastolic volume (Figure B). The mean increase in cardiac index (CI) by IABPs among all AHF patients was 27± 13%. An increase in CI > 20% was observed in 50% of AHF patients (n=5). Compared to Non-Responders, Responders had lower LVEDP, higher LVESP, higher ESPVR, and a trend towards greater dP/dTmax before IABP activation. Responders had intact RV function including lower right atrial (RA) pressures, a higher pulmonary artery pulsatility index (PAPi) and lower RA:Pulmonary Capillary Wedge Pressure ratios (RA:PCWP).
Conclusions: This is the first-in-man analysis of IABPs in AHF using parameters from both the pressure-volume and pressure-time domains. IABP therapy reduces LV stroke work by reducing LVESP. Responders had better pre-IABP LV and RV hemodynamics than Non-Responders. The utility of IABP therapy in AHF requires further study.
Author Disclosures: S. Annamalai: None. L. Buitten: None. M. Esposito: None. A. Mullin: None. C. Breton: None. R. Pedicini: None. C. Kimmelstiel: None. M. Kiernan: None. D. Denofrio: None. R. Karas: None. N.K. Kapur: Research Grant; Significant; Maquet.
- © 2016 by American Heart Association, Inc.