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Ann Thorac Surg 2005;79:872-880
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Beat-to-Beat Effects of Intraaortic Balloon Pump Timing on Left Ventricular Performance in Patients With Low Ejection Fraction

^a Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
^b Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
^c Arrow International, Reading, Pennsylvania

Accepted for publication July 29, 2004.

^* Address reprint requests to Dr Schreuder, Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy; (E-mail: schreuder{at}libero.it).

BACKGROUND: Intraaortic balloon counterpulsation (IABP) timing errors during arrhythmia may result in afterload increases which may negatively influence left ventricular (LV) ejection and LV mechanical dyssynchrony. The aim of our study was to determine beat-to-beat effects of properly timed IABP, premature IAB inflation, and late IAB deflation on LV performance and LV mechanical dyssynchrony in heart failure patients undergoing cardiac surgery.

METHODS: In 15 patients, LV pressure-volume relations and LV dyssynchrony were measured by conductance volume catheter. Properly timed IABP was evaluated at a 1:1 assist ratio within a 10 seconds time-span. Premature IAB inflation and late IAB deflation were evaluated at a 1:4 assist ratio.

RESULTS: Properly timed 1:1 IABP acutely decreased LV end-systolic volume by 6.1% (p < 0.0001) and LV end-systolic pressure by 17.5% (p < 0.0001) due to decreased aortic impedance. Stroke volume (SV) increased by 14% (p < 0.0001), which correlated markedly with a decrease of LV mechanical dyssynchrony (p < 0.0001). The largest SV increases occurred in patients with lowest contractile state. Premature IAB inflation decreased SV by 20% (p < 0.0001) due to abrupt increase of LV afterload during late ejection. Late IAB deflation increased SV and stroke work by 18% (p < 0.0001) and 16% (p < 0.01) respectively, due to increased afterload during early ejection and decreased afterload during late ejection.

CONCLUSIONS: Left ventricular performance during IABP is causally related to changes in LV afterload, and the timing of these changes in relation to contraction or relaxation phases, to LV mechanical dyssynchrony and to contractile state.

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Automatic Intraaortic Balloon Pump Timing Using an Intrabeat Dicrotic Notch Prediction Algorithm

Jan J. Schreuder, Alessandro Castiglioni, Andrea Donelli, Francesco Maisano, Jos R.C. Jansen, Ramzi Hanania, Pat Hanlon, Jan Bovelander, and Ottavio Alfieri
Ann. Thorac. Surg. 2005 79: 1017-1022. [Abstract] [Full Text] [PDF]

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				J.J. Schreuder, A. Donelli, and O. Alfieri Reply to the Editor J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 615 - 617. [Full Text] [PDF]