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%.

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 A simulation study of left ventricular decompression using a double lumen arterial cannula prototype during a veno-arterial extracorporeal membrane oxygenation

2019 ◽  
Vol 42 (12) ◽  
pp. 748-756
Author(s):  
Filip Ježek ◽  
Svitlana Strunina ◽  
Brian E Carlson ◽  
Jiří Hozman
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Cardiovascular System ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Ventricular Contractility ◽  
Double Lumen ◽  
Membrane Oxygenation ◽  
Arterial Cannula

Background: Veno-arterial extracorporeal membrane oxygenation can be vital to support patients in severe or rapidly progressing cardiogenic shock. In cases of left ventricular distension, left ventricular decompression during veno-arterial extracorporeal membrane oxygenation may be a crucial factor influencing the patient outcome. Application of a double lumen arterial cannula for a left ventricular unloading is an alternative, straightforward method for left ventricular decompression during extracorporeal membrane oxygenation in a veno-arterial configuration. Objectives: The purpose of this article is to use a mathematical model of the human adult cardiovascular system to analyze the left ventricular function of a patient in cardiogenic shock supported by veno-arterial extracorporeal membrane oxygenation with and without the application of left ventricular unloading using a novel double lumen arterial cannula. Methods: A lumped model of cardiovascular system hydraulics has been coupled with models of non-pulsatile veno-arterial extracorporeal membrane oxygenation, a standard venous cannula, and a drainage lumen of a double lumen arterial cannula. Cardiogenic shock has been induced by decreasing left ventricular contractility to 10% of baseline normal value. Results: The simulation results indicate that applying double lumen arterial cannula during veno-arterial extracorporeal membrane oxygenation is associated with reduction of left ventricular end-systolic volume, end-diastolic volume, end-systolic pressure, and end-diastolic pressure. Conclusions: A double lumen arterial cannula is a viable alternative less invasive method for left ventricular decompression during veno-arterial extracorporeal membrane oxygenation. However, to allow for satisfactory extracorporeal membrane oxygenation flow, the cannula design has to be revisited.

scholarly journals Efficacy and Safety of ProGlide Versus Prostar XL Vascular Closure Devices in Transcatheter Aortic Valve Replacement: The RISPEVA Registry

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Sergio Berti ◽  
Francesco Bedogni ◽  
Arturo Giordano ◽  
Anna S. Petronio ◽  
Alessandro Iadanza ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Vascular Complications ◽  
Bleeding Complications ◽  
Efficacy And Safety ◽  
End Point ◽  
Transcatheter Aortic Valve ◽  
Vascular Closure Devices ◽  
Score Analysis

Background Transcatheter aortic valve replacement (TAVR) requires large‐bore access, which is associated with bleeding and vascular complications. ProGlide and Prostar XL are vascular closure devices widely used in clinical practice, but their comparative efficacy and safety in TAVR is a subject of debate, owing to conflicting results among published studies. We aimed to compare outcomes with Proglide versus Prostar XL vascular closure devices after TAVR. Methods and Results This large‐scale analysis was conducted using RISPEVA, a multicenter national prospective database of patients undergoing transfemoral TAVR treated with ProGlide versus Prostar XL vascular closure devices. Both multivariate and propensity score adjustments were performed. A total of 2583 patients were selected. Among them, 1361 received ProGlide and 1222 Prostar XL. The predefined primary end point was a composite of cardiovascular mortality, bleeding, and vascular complications assessed at 30 days and 1‐year follow‐up. At 30 days, there was a significantly greater reduction of the primary end point with ProGlide versus Prostar XL (13.8% versus 20.5%, respectively; multivariate adjusted odds ratio, 0.80 [95% CI, 0.65–0.99]; P =0.043), driven by a reduction of bleeding complications (9.1% versus 11.7%, respectively; multivariate adjusted odds ratio, 0.76 [95% CI, 0.58–0.98]; P =0.046). Propensity score analysis confirmed the significant reduction of major adverse cardiovascular events and bleeding risk with ProGlide. No significant differences in the primary end point were found between the 2 vascular closure devices at 1 year of follow‐up (multivariate adjusted hazard ratio, 0.88 [95% CI, 0.72–1.10]; P =0.902). Comparable results were obtained by propensity score analysis. During the procedure, compared with Prostar XL, ProGlide yielded significant higher device success (99.2% versus 97.5%, respectively; P =0.001). Conclusions ProGlide has superior efficacy as compared with Prostar XL in TAVR procedures and is associated with a greater reduction of composite adverse events at short‐term, driven by lower bleeding complications. Registration Information URL: clini​caltr​ials.gov ; Unique identifier: NCT02713932.

scholarly journals Use of levosimendan in cardiogenic shock

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 296
Author(s):  
Fayçal Janen ◽  
Khaoula El Arayedh ◽  
Iheb Labbene ◽  
Chihebeddine Romdhani ◽  
Mustapha Ferjani
Keyword(s):  
Arterial Pressure ◽  
Cardiogenic Shock ◽  
Diastolic Pressure ◽  
Rescue Therapy ◽  
Systolic Pressure ◽  
Tissue Perfusion ◽  
Military Hospital ◽  
Mean Pulmonary Arterial Pressure ◽  
Pulmonary Arterial ◽  
The Military

Cardiogenic shock (CS) is acute inadequate tissue perfusion caused by the heart's inability to pump an adequate amount of blood. Due to the failure of classic inotrope agents, a sensitizer agent, levosimendan, has been used as a rescue therapy in such situations. In order to assess the effectiveness of levosimendan to treat CS, we studied its hemodynamic effects on patients with CS. A retrospective study was conducted at the ICU of the Military Hospital of Tunis between January 2004 and December 2009, and between January 2011 and December 2013. Twenty-six patients with CS refractory to catecholamines were included in our study. When catecholamines failed to improve the hemodynamic condition, levosimendan was introduced. This treatment was administered in two steps: a loading dose of 12 µg/kg/min was infused for 30 min; and then continuous infusion was given for 24 h at a dose of 0.1 µg/kg/min. Levosimendan significantly increased mean arterial pressure to 76 ± 7 mmHg at 48 h and cardiac index to 3.19 ± 0.68 L/min/m2 and decreased pulmonary wedge pressure to 17 ± 3 mmHg at 48 h. Pulmonary arterial systolic pressure, pulmonary arterial diastolic pressure, and mean pulmonary arterial pressure were significantly reduced at 24 h. A significant decrease in lactate from 3.77 ± 2.93 to 1.60 ± 1.32 mmol/L, by 72 h, was also noted. Levosimendan significantly reduced systemic vascular resistance and pulmonary vascular resistances. Administration of levosimendan also reduced the need for catecholamines. Our study confirms the efficacy of levosimendan to stabilize hemodynamic parameters in patients with CS.

Exaggerated wave reflection in the kangaroo simulates arterial counterpulsation

1984 ◽  
Vol 246 (2) ◽  
pp. R267-R270
Author(s):  
A. P. Avolio ◽  
W. W. Nichols ◽  
M. F. O'Rourke
Keyword(s):  
Pressure Wave ◽  
Wave Reflection ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Peripheral Circulation ◽  
Aortic Pressure ◽  
Pulse Contour ◽  
Aortic Impedance ◽  
Intra Aortic Balloon Counterpulsation ◽  
Balloon Counterpulsation

The ascending aortic pressure wave in kangaroos is quite different from that seen in other experimental animals and in humans, despite an ascending aortic flow wave that is virtually identical. The diastolic pressure surge in the ascending aortic pressure wave of kangaroos is very prominent--so much so that peak diastolic pressure is often greater than peak systolic pressure, with the pressure wave resembling that recorded in humans during intra-aortic balloon counterpulsation. Ascending aortic impedance patterns in kangaroos indicate the presence of a single functionally discrete reflecting site in the peripheral circulation, with high reflection coefficient. All findings--of pulse contour and impedance patterns--are explicable on the basis of arterial anatomy and body shape. Wave reflection from the distant, large, and vascular lower body appears to dominate the effects of wave reflection from the short, small, and less vascular head and forelimb system.

scholarly journals Association between blood pressure and the risk of biopsy-induced endobronchial hemorrhage during bronchoscopy

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Saibin Wang ◽  
Qian Ye
Keyword(s):  
Lung Cancer ◽  
Blood Pressure ◽  
Regression Analysis ◽  
Multivariate Regression ◽  
Diastolic Pressure ◽  
Tertiary Care ◽  
Systolic Pressure ◽  
Multivariate Regression Analysis ◽  
Care Hospital ◽  
Hemorrhage Risk

Abstract Background Hemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage. Methods We conducted a retrospective cohort study of 643 consecutive adults with lung cancer over an approximately 4-year period (from January 2014 to February 2018) at a large tertiary care hospital. Patients were divided into the hemorrhage group and the non-hemorrhage group based on endobronchial biopsy (EBB) findings. The association between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), PP to DP ratio (PP/DP) and the risk of EBB-induced hemorrhage was evaluated using multivariate regression analysis and smooth curve fitting adjusted for potential confounding factors. Results The EBB-induced bleeding incidence was 37.8% (243/643) in our cohort. An independent association was found between PP/PD and the EBB-induced hemorrhage risk (per 1 SD, adjusted odds ratio, 0.788; 95% confidence interval, 0.653-0.951). The multivariate regression analysis performed using quartiles of PP/DP revealed that lower level of PP/DP ratio was related to a higher risk of EBB-induced hemorrhage (P for trend <0.05) after adjustment for potential confounders. However, no association was observed between SP, DP, MAP, PP and EBB-induced hemorrhage. Conclusions Low PP/DP was the independent risk factor for biopsy-induced endobronchial hemorrhage during bronchoscopy in patients with lung cancer.

scholarly journals Prognostic value of ambulatory blood pressure in chronic kidney disease

2018 ◽  
Vol 5 (6) ◽  
pp. 1337
Author(s):  
S. Senthil Kumar ◽  
S. Vithiavathi ◽  
P. Parameswaran
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ambulatory Blood Pressure ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Vascular Complications ◽  
Early Morning ◽  
Nocturnal Hypertension ◽  
The Mean

Background: Hypertension control is essential to prevent macro vascular complications in patients with chronic kidney disease. Ambulatory Blood Pressure Monitoring (ABPM) is the recognized gold standard for the assessment of hypertension and hence in this study ABPM assessment was done in 50 patients with dialysis dependant CKD to evaluate the adequacy of BP control and prevent adverse events.Methods: This study is a prospective observational study conducted at Aarupadai Veedu Medical College and Hospital, Pondicherry among hypertensive patients with dialysis dependant CKD patients as per standard criteria. A total of 50 patients participated in this study of both gender after obtaining written consent. Patients with coronary artery disease, diabetes mellitus, acute kidney injury were excluded from this study.Results: Out of the total 50 patients included in this study 72% had early morning dipping in BP and remaining 28% had non-dipping in systolic and diastolic pressure. The mean systolic pressure reached a maximum of 160.95mmHg to a minimum of 113.38mmHg and the mean diastolic pressure with a maximum of 98.47 to a minimum of 62.71mmHg on an overall 24 hours ABPM monitoring. The mean systolic and diastolic pressure was found to be more in the active period than in the passive period.Conclusions: Nocturnal BP is superior to day time BP in predicting CVD outcomes. This study shows both systolic and diastolic pressure variability over 24hrs maximum during night hours (nocturnal hypertension) and non-dipping of early morning BP. Both non-dipping status and nocturnal hypertension are associated with target organ damage and CV risk.

scholarly journals Prevalence of Hypertension in Patients with Nephrolithiasis

2021 ◽  
pp. 92-96
Author(s):  
I. Adhavan ◽  
S. Prasanna Karthik
Keyword(s):  
Blood Pressure ◽  
Kidney Stone ◽  
Diastolic Pressure ◽  
Tertiary Care ◽  
Systolic Pressure ◽  
Stone Disease ◽  
Kidney Stone Disease ◽  
Arterial Blood ◽  
Stone Formers ◽  
Study Participants

Introduction: Kidney stone disease, also known as nephrolithiasis, is a prevalent illness that affects people of all ages and genders. Hypertension is defined as persistent elevation of systemic arterial blood pressure (systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg). Methodology: This was a prospective study conducted over a period of 3 months between February 2021 and April 2021 at the Department of General Medicine in our tertiary care center. A total of 280 patients who came to the outpatient department (OPD) were included in the study as study participants. After recording blood pressure, participants were classified as normotensives (218) and hypertensives (62).  The study participants were examined for the development of kidney stone disease. In those study participants who had clinical features suggesting nephrolithiasis, the diagnosis was confirmed by Ultrasonography. Results: It was observed that 25 of 62 hypertensives and 47 of 218 normotensives developed nephrolithiasis. And there were 43 men and 29 women among the 72 stone formers. Conclusion: Our study showed a male preponderance for stone formers. And it is also evident that nephrolithiasis is more prevalent among hypertensives than normotensives though not statistically significant.

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