Specific changes of hemodynamics with intra-aortic balloon contrapulsation in patients with acute heart failure after cardiac surgery
Abstract
The intra-aortic balloon contrapulsation (IABP) is one of most simple circulatory assistance method for patients with acute heart failure after CABG and heart valve replacement surgery. The main problem is how to stop it without acute heart failure (AHF) recurrence. Therefore, estimation of hemodynamics compensation cost at final stages of IABP is actual task.
Objective. To develop criteria and approaches to minimize the risk of recurrence of AHF and cardiogenic shock after the end of the IABP on the basis of studies on the interaction of central and peripheral circulation.
Materials and Methods. The database includes 719 adult patients who were screened 1-2 days after cardiac surgery. The IABP was performed in 96 patients before or after surgery.
Results and discussion. The analysis of blood pressure curves and hemodynamic parameters with IABP showed that coronary blood flow increased during inflation, PDIA and systemic perfusion increased. When the balloon is blown off, the ejection phase is shortened, post-load decreases, the volume of the left ventricular output and the cardiac output increases.
During IABC, the final diastolic pressure in the aorta are reduced. It was also found that two factors affect the regulation of systemic hemodynamics with AHF: Bainbridge reflex and close correlation between the volume of circulating blood and the systemic vessels resistance.
The study showed a significant difference in the dynamics of lactate and NT-proBNP in the blood of the patients of the two groups after cardiogenic shock with or without IABP.
Conclusion. All considered approaches are additional to standardly using and allow estimate the cost of physiologic compensation of low cardiac output. Additionally to known clinical indications this study allowed to formulate the following criteria for safe IABS finalizing: steady heart rhythm (stable sinus or atrial fibrillation); normal range ratio of PDIA and heart rate; close to preoperative values heart rate; the ratio of PSYS/PDIA>0,6, which indicates the normalization of conditions of the microcirculatory system functioning. The diagrams developed are convenient for estimation of state of hemodynamics on the stages of IABP application.
References
2. Knyshov G., Nastenko Ie., Maksymenko V., Beregovoi O., Didyk M., Nosovets O. Intraaortic balloon support. How to exit safely? Proceeding of the 15th European Congr. on Extra-Corporeal Circulation Technol., June 12th-15th. – 2013. – Toledo, Spain. – P. 304–316.
3. Shramek B. Bo. Systemic hemodynamics and hemodynamic management. – US // Instantpublisher. com. – 2002. – 127 p.
4. Книшов Г. В., Настенко Є. А., Максименко В. Б., Носовець О. К., Матвійчук А. О., Распутняк О. В. Деклар. Пат. на корисну модель № 70139 «Спосіб оцінки функціонального стану системи кровообігу» Держ. деп. інтел. власн. Бюл. № 10, 25.05.2012 .
5. Effects of Left Ventricular Assist Device Support on Biomarkers of Cardiovascular Stress, Fibrosis, Fluid Homeostasis, Inflammation, and Renal Injury CME / Ahmad T., Wang T., Hilberman E. et al. // JCHF. – 2015. – Vol. 3 (1). – P. 30–39.
6. IABP: history-evolution-pathophysiology-indications: what we need to know / Parissis H., Graham V., Lampridis S. et al. // J Cardiothorac Surg. – 2016 Aug 4. – Vol. 11 (1). – P. 122.
7. Percutaneous short-term active mechanical support devices in cardiogenic shock: a systematic review and collaborative meta-analysis of randomized trials / Thiele H., Jobs A, Ouweneel D. M. // Eur Heart J. – 2017 Jul 7.
8. Coronary and microvascular physiology during intra-aortic balloon counterpulsation / De Silva K., Lumley M., Kailey B. et al. // JACC Cardiovasc Interv. – 2014. – Vol. 7. – P. 631–640.
9. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock / Unverzagt S., Buerke M., de Waha A. // Cochrane Database Syst Rev. – 2015 Mar 27.
10. Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: a meta-analysis / Bahekar A., Singh M., Singh S. et al. // American Heart Journal. – 2012. – Vol. 164. – P. 58–64.
11. A meta-analysis on efficiency of intra-aortic balloon pump therapy in patients with acute myocardial infarction / Zhang X. R., Su L., Chen S. J. et al. //. Chinese Journal of Cardiovascular Disease (Zhonghua Xin Xue Guan Bing Za Zhi) 2013. – Vol. 41 (5). – P. 432–7.
