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Faculty of Medical Sciences

Intra-aortic balloon pumps in advanced heart failure. A pressure volume loop analysis.

Buiten, L. (Lyanne) (2015) Intra-aortic balloon pumps in advanced heart failure. A pressure volume loop analysis. thesis, Medicine.

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Abstract

Over 140,000 intra-aortic balloon counterpulsation pumps (IABPs) are implanted worldwide annually. No studies have examined the effects of IABPs in heart failure. In this pilot study we explored hemodynamic effects of the 50cc IABP in patients with advanced heart failure. Methods: In eight patients with stage D, NYHA class 3 or 4 referred for non-emergent IABP placement, a conductance catheter was placed into the left ventricle (LV) to generate pressure-volume loops. After baseline recordings, 50cc IABP was activated for ten minutes, while data recording continued. Next, the IABP was stopped for ten minutes and 10cc was removed from the IABP circuit. After second baseline measurements, the IABP was activated for ten minutes on 40cc capacity with ongoing data acquisition. Results: Mean age of the patients was 58±14 years with an LV ejection fraction of 15±8%. The 50cc IABP reduced LV stroke work (SW: 1666±760 vs 1260±774 mmHg x mL, p=0.00769), end-systolic pressure (ESP: 89±24 vs 75±23 mmHg, p=0.00763) and +dPdTmax (868±225 vs 744±220 mmHg/sec, p=0.00763). The IABP with 40cc of volume displacement reduced ESP (94±19 vs 84±20, p=0.00742) and +dPdTmax (890±171 vs 810±179, p=0.00769). Both 50cc and 40cc IABP increased aortic diastolic pressures and reduced systolic pressures. LV volumes and end-diastolic pressure were not significantly altered with IABP activation. The 50cc IABP reduces ESP significantly more than the 40cc IABP, p=0.0109). Conclusion: This is the first study of large capacity IABPs using conductance catheters in patients with advanced heart failure. The 50cc IABP reduced LV stroke work primarily by reducing LV end-systolic pressure with minimal effect on LV volumes. Further study is required to make definitive conclusions.

Item Type: Thesis (Thesis)
Supervisor name: Rienstra, Dr. Michiel
Supervisor name: Kapur, Dr. Navin K. and Tufts Medical Center and Boston/Massachusetts and United States of America
Faculty: Medical Sciences
Date Deposited: 25 Jun 2020 10:52
Last Modified: 25 Jun 2020 10:52
URI: https://umcg.studenttheses.ub.rug.nl/id/eprint/1286

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