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Improvement of right ventricular function with intraaortic balloon pump counterpulsation
Authors:
MJ Bonios1, I Armenis1, N Kogerakis1, A Gkouziouta1, E Leontiadis1, P Georgiadou1, S Fragkoulis1, S
Dimopoulos1, D Tsiapras1, P Vlachos1, S Adamopoulos1, 1Onassis Cardiac Surgery Center Athens
Greece,
Topic(s):
Ventricular Assist Devices
Citation:
Introduction:
Right Ventricular (RV) Failure occurrence after Left Ventricular Assist Device (LVAD) implantation is a major
contributor to morbidity and mortality among patients with endstage biventricular heart failure. On the other
hand, patients who require biventricular support (BiVAD) consistently show worse outcome compared to
LVAD recipients.
Purpose:
Purpose of this study was to investigate the effect of Intraaortic Balloon Pump counterpulsation (IABP) on RV
function in candidates for mechanical circulatory support due to endstage biventricular heart failure.
Methods:
Patients with endstage heart failure who required IABP support due to haemodynamic compromise were
studied. RV function before and after IABP placement was studied echocardiographically (legacy methods and
free wall RV strain analysis) and haemodynamically (invasive right heart catheterization). Specific laboratory
parameters were also obtained. Pairedsamples Student Ttest was applied to compare values before and after
IABP placement.
Results:
Twelve patients with endstage heart failure aged 35±13 years were supported with IABP for 73±58 (3180)
days. Haemodynamic compromise was the indication for IABP placement in 11/12 patients and further analysis
refers to this population. Two out of 11 patients presented further clinical deterioration on IABP and required
temporary/longterm BiVAD support, while 2 patients got stabilized on IABP but without significant
amelioration, one of them receiving BiVAD on a nonurgent basis and the other dying on IABP due to infection.
RV function significantly recovered in 7 patients. In the cohort of 11 patients, Central Venous Pressure (CVP)
decreased from 18±6 to 11±9 mmHg (p=0.014), CVP/Pulmonary Capillary Wedge pressure decreased from
0.61±0.19 to 0.42±0.20 (p=0.022) and Pulmonary Artery Pulsatility index (PAPi) increased from 1.32±0.56
to 2.76±1.30 (p=0.009). RV free wall strain also improved from 12.6±4.4% to 17.5±3.0% (p=0.013). The
above parameter optimization rendered the patients suitable for LVAD implantation, despite initial biventricular
compromise.
Conclusion:
In patients with endstage biventricular heart failure, IABP placement might improve RV function and alter
mechanical support type (LVAD instead of BiVAD), with potential morbidity and mortality benefits.
In patients with endstage biventricular heart failure, IABP placement might improve RV function and alter
mechanical support type (LVAD instead of BiVAD), with potential morbidity and mortality benefits.