A single center tertiary care experience utilizing the large volume mega 50cc intra-aortic balloon counterpulsation in contemporary clinical practice

2017 ◽  
Vol 90 (4) ◽  
pp. E63-E72 ◽  
Author(s):  
Gautam K. Visveswaran ◽  
Marc Cohen ◽  
Ahmed Seliem ◽  
Michael DiVita ◽  
Jonathan K. R. McNamara ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Large Volume ◽  
Tertiary Care ◽  
Single Center ◽  
Care Experience ◽  
Intra Aortic Balloon Counterpulsation ◽  
Balloon Counterpulsation

Abstract 13087: Are All Patients Equal in Response to Intra-Aortic Balloon Counterpulsation?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David A Baran ◽  
Marc Cohen ◽  
Gautam K Visveswaran ◽  
Michael DiVita ◽  
Ahmed Seliem ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Chart Review ◽  
Tertiary Care ◽  
Balloon Catheter ◽  
Binary Response ◽  
Ventricular Assist ◽  
Care Experience ◽  
Intra Aortic Balloon Counterpulsation ◽  
Balloon Counterpulsation ◽  
Hemodynamic Measurements

Background: Intra-Aortic Balloon Counterpulsation (IABC) with a 50 cc (MEGA 50™) balloon catheter is associated with an average increase of 0.5- 0.7 liters/min in cardiac output. However, some patients (pts) have a much more dramatic response. We retrospectively analyzed our single center tertiary care experience with 150 consecutive pts undergoing IABC. Methods: Chart review for demographic, procedural, and hemodynamic data was collected for 150 pts of whom 64 had both pre and 4 hour post IABC hemodynamic measurements. The responder (R) group was defined by any positive change in cardiac output (CO) and cardiac index (CI) between baseline prior to IABC and 4 hours post initiation. Non-responders (NR) were defined as those with a decline in CO or no change. Results: IABC with a 50 cc balloon was associated with a significant improvement in CO of 0.7 L/min for the overall cohort (Pre-IABC mean CO 3.9±1.4 vs post 4.6 ±1.6 L/Min, paired t-test p=.0004). There were 38 pts in the R group (60 %) and 26 in the NR group. The CO / CI post-IABC improved significantly: CO 3.5±1.3 to 5.0±1.7 L/Min and CI 1.8±0.6 vs 2.6±0.7 L/min/M 2 ) (p<0.0001). For NR pts, CO dropped from 4.5±1.3 to 3.9±1.2 L/Min (p<0.0001) and CI from 2.2±0.6 to 2.1±0.5 L/min/M 2 (p=0.1). Interestingly, systemic vascular resistance varied significantly between groups (R: 1568±657 vs NR 1218±461 (dyne*sec)/cm 5 (p=0.02). Nominal logistic regression identified pre-IABC CO as a significant predictor of response. Conclusion: Among a cohort of pts receiving IABC, there appears to be a binary response with “responders” augmenting CO by 1.5 L/min which is close to that provided by percutaneous ventricular assist catheters such as Impella. Patients with lower pre-IABC CO and higher SVR appear to have the most favorable response to IABC. This binary response may have influenced prior neutral clinical outcome trials of IABC.

scholarly journals Clinical Characteristics and Outcome of Patients With Pheochromocytoma: A Single Center Tertiary Care Experience

Cureus ◽  
2020 ◽  
Author(s):  
Sara Sohail ◽  
Waqas Shafiq ◽  
Syed Abbas Raza ◽  
Adnan Zahid ◽  
Khurram Mir ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Tertiary Care ◽  
Single Center ◽  
Care Experience

Intra-aortic balloon counterpulsation timing

1996 ◽  
Vol 5 (4) ◽  
pp. 254-261 ◽  
Author(s):  
CA Cadwell ◽  
SJ Quaal
Keyword(s):  
Clinical Practice ◽  
Aortic Valve ◽  
Valve Closure ◽  
Limited Information ◽  
Qrs Complex ◽  
Clinical Implementation ◽  
Early Systole ◽  
Aortic Valve Closure ◽  
Intra Aortic Balloon Counterpulsation ◽  
Balloon Counterpulsation

Intra-aortic balloon counterpulsation is a product of an endeavor begun more than 3 decades ago. First the concept, then applications of inflating a nonthrombogenic balloon within the aorta during diastole were explored. The intra-aortic balloon is timed to inflate with aortic valve closure. Two options are available for deflation timing: (1) conventional timing, where deflation is estimated to be completed at some point during isovolumetric contraction, prior to ejection; and (2) R wave deflation, also known as real timing, where deflation is triggered by each QRS complex to occur during isovolumetric contraction or early systole. Although clinical implementation of both conventional and real timing was introduced in 1968, limited information about these methods of deflation is currently available. This article elucidates the differences between these models and suggests implications for clinical practice and further research.

Abstract 13081: Large Volume Intra-Aortic Balloon Counterpulsation: Efficacy and Safety of the Mega 50cc in 150 Consecutive Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gautam K Visveswaran ◽  
Marc Cohen ◽  
Michael Divita ◽  
Ahmed Seliem ◽  
Amar Dave ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Diastolic Pressure ◽  
Tertiary Care ◽  
Systolic Pressure ◽  
Vascular Complications ◽  
Outcome Data ◽  
Bleeding Complications ◽  
Efficacy And Safety ◽  
Care Experience ◽  
Balloon Counterpulsation

Background: Intraaortic balloon counterpulsation (IABC) with the larger volume (LV) 50 cc Mega balloon offers greater aortic diastolic augmentation and systolic unloading than its 40cc predecessor. We retrospectively analyzed our single center tertiary care experience with 150 consecutive patients (pts) with LV IABC to gauge its efficacy and safety. Methods: Retrospective chart review for demographic, procedural, safety and in-hospital outcome data was undertaken on 150 pts. In 64 pts, hemodynamic data by Swan was available pre- IABC, and 4, 24, and 48 hours during IABC. Results: LV IABC was deployed for cardiogenic shock and/or CHF (n=128), coronary ischemia (n=11), or high risk PCI/surgery (n=11): Mean age 58±15 with 18% over age 80, 21% female, 36% % African-American. The median LVEF was 22% (15.3%-33.2%) and 37% were non-ischemic myopathy. 19% of IABC insertions were emergent at bedside without fluoroscopy. Median duration of IABC was 92 hrs (48hrs-235 hrs) during which a leak or poor augmentation developed in 3%. 3(2%) pts had major vascular complications; 3(2%) pts had major bleeding. 51(34%) pts escalated from IABC to Impella, LVAD, or heart transplantation. Overall, in-hospital mortality was 27%. In the subgroup of 100 pts in whom IABC was the initial therapy for cardiogenic shock mortality was only 32%. Hemodynamic data (64 pts) pre-IABC vs 48 hrs: Aortic systolic pressure decreased (mean systolic unloading) -10.7 +/-25 mmHg; absolute Aortic diastolic pressure (augmented dias AoP) 108 ± 22mmHg; mean PA decreased -5.4±11; mean RA -3.2±6 (all p <0.05). Cardiac output and index increased by of 0.7±1.6 l/min, and 0.4±0.8 l/min/m2 respectively (p<0.005). Conclusion: LV IABC with the 50cc Mega balloon is a safe first line percutaneous support strategy in critically ill pts with easy bed-side deployment and relatively few device related complications. Despite conflicting results from clinical trials, we observed, a significant improvement in hemodynamic indices in a broad range of pts with relatively few vascular and bleeding complications with IABC. Among the 100 pts in whom IABC was the initial ventricular assist therapy for cardiogenic shock, survival to hospital discharge was 68%.

scholarly journals Fetal echocardiography: A single-center tertiary care experience

Heart India ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 52
Author(s):  
Aamir Rashid ◽  
Shaheera Ajaz ◽  
Hilal Rather ◽  
Aabida Ahmed ◽  
Rabiya Khursheed ◽  
...  
Keyword(s):  
Fetal Echocardiography ◽  
Tertiary Care ◽  
Single Center ◽  
Care Experience
Sign in / Sign up

Export Citation Format

Share Document