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Transient mechanical support of the failing heart

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Invasive Cardiovascular Therapy

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 57))

Summary

Mechanical aids for the failing heart are necessary in patients with postoperative low—output syndrome (LOS) following cardiac surgery and in cardiologic patients with impending cardiogenic shock due to unstable angina pectoris and acute myocardial infarction (MJ). The IABP is routinely used either in the ICU, the catheter laboratory or in the operation room. Its hemodynamic effects improve the myocardial energy imbalance by a reduction in systolic and an increase in diastolic arterial pressure. The device generally produces a 10% to 20% increase in cardiac output (CO) and at the same time enhances the coronary blood flow (CBF). Nowadays the balloon—catheter is usually inserted transcutanously via femoral artery into the thoracic aorta. From 1975 to 1984, 138 patients (pts) of 6022 pts undergoing open heart surgery at the University of Goettingen required IABP. Another group of 28 pts with cardiogenic shock following acute myocardial infarction without cardiac surgery needed IABP-treatment. Only 28,5% (n = 8) could be weaned from IABP, and 5 pts were discharged from the hospital. Our experience show the coronary artery disease group of IABP patients to be increasing, whereas the intra— and postoperative groups are decreasing, probably as a result of better intraoperative myocardial protection by cardioplegia. Partial venoarterial bypass (VABP) in combination with IABP is hemo— dynamically more effective than IABP and can be used in more severe LOS and in presence of right heart failure. Our own experimental results indicate, that VABP of only 35% of cardiac output (CO) combined with IABP can be an effective method to support the failing heart. A bypass of 48% of CO decreased significantly dp/dtmax (30%) and calculated myocardial oxygen requirement (E.g. according to Bretschneider, 16%). A simple system is the combination of VAPB cannulating the axillary artery and IABP.

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References

  1. Bernhard WF, La Farge CG, Bernhorst WJ (1973) Development of a left ventricle—to—aorta assist device. Final Progress Report to Division of Technological Applications, National Heart and Lung Institute, U.S. National Institutes of Health. PH 43–67–1116–6, pp 1–130

    Google Scholar 

  2. Bernstein EF, De Laria GA, Johansen KH, Shuman RL, Stasz P, Reich S (1975) Twenty—four hour left ventricular bypass with a centrifugal blood pump. Ann Surg 181, 412–417

    Article  Google Scholar 

  3. Bolooki H, Williams W, Thurer RJ, Vargas A, Kaiser GA, Mack F, Charamani AR (1976) Clinically and hemodynamic criteria for use of the intra—aortic balloon pump in patients requiring cardiac surgery. J Thorac Cardiovasc Surg 72, 756

    PubMed  CAS  Google Scholar 

  4. Bregman D (1981) Intraaortic Balloon Counterpulsation. In: Ionescu M (ed) Techniques in Extracorporal Circulation. Second Edition. London: Butterworths, pp 516–600

    Google Scholar 

  5. Bregman D, Parodi EN, Haubert SJ, Szarnicki R, Edie RN, Spotnitz HM, Bowman FO Jr, Reemtsma K, Malm JR (1977) Counterpulsation with a new pulsatile assist device ( PAD) in open heart surgery. Med Instrum 11, 292

    Google Scholar 

  6. Bregman D, Parodi EH, Haubert SJ, Szarnicki R, Edie RN, Spotnitz HM, Bowman FO Jr, Reemtsma K, Malm JR (1977) Unidirectional intra—aortic balloon pumping and counterpulsation during open heart surgery. In: Bregman D, Mechanical support of the failing heart and lungs. New York: Appleton-Century-Crofts

    Google Scholar 

  7. Bregman D, Bailin M, Bowman FO Jr, Parodi EN, Haubert SM, Edie RN, Spotnitz HM, Reemtsma K, Malm JR (1977) A pulsatile assist device ( PAD) for improved myocardial protection during cardiopulmonary bypass. Ann Thorac Surg 24, 574

    Article  PubMed  CAS  Google Scholar 

  8. Bretschneider HJ (1972) Die hamodynamischen Determinanten des myokardialen Sauerstoff— verbrauches. In: Dengler HJ (Hrsg): Die therapeutische Anwendung (3-sympathikolytischer Stoffe. Schattauer, Stuttgart-New York, S. 45

    Google Scholar 

  9. Buckly MJ, Craver JM, Gold HK, Mundth ED, Daggett WM, Austen WG (1973) Intraaortic balloon pump assist for cardiogenic shock after cardiopulmonary bypass. Circulation Suppl III 47, 48, 90–94

    Google Scholar 

  10. De Bakey ME (1971) Left ventricular bypass pump for cardiac assistance: Clinical experience. Am J Cardiol 27, 3

    Article  Google Scholar 

  11. Dennis C, Hall DP, Moreno JR, Senning A (1962) Reduction of the oxygen utilization of the heart by left bypass. Circ Res 10, 298

    PubMed  CAS  Google Scholar 

  12. Derks C, Jaspar N, Francquen de Ph, Vanderhoeft P (1976) Extracorporeal oxygenation with various experimental venoarterial bypass during prolonged apnea. Thorac Cardiovasc Surg 71, 666– 672

    Google Scholar 

  13. Disler PB, Scott Miliar RN, Obel IWP (1978) Prolonged circulatory support with the intra—aortic balloon pump after myocardial infarction. Thorax 33, 504

    Article  PubMed  CAS  Google Scholar 

  14. Feola M, Wiener L, Walinsky P, Kasparian H, Duca P, Gottlieb R, Brest A, Templeton J (1977) Improved survival after coronary bypass surgery in patients with poor left ventricular function: role of intra—aortic balloon counterpulsation. Amer J Cardiol 39, 1021

    Article  PubMed  CAS  Google Scholar 

  15. Gold HK, Leinbach RC, Buckley MJ, Mundth ED, Daggett WM, Austen WG (1976) Refractory angina pectoris: follow—up after intra—aortic balloon pumping and surgery. Circulation 54 (Suppl III), 41

    Google Scholar 

  16. Gunstensen J, Goldmann BS, Scully HS, Hukkell VF, Adelman AG (1976) Evolving indications for preoperative intra—aortic balloon pump assistance. Ann Thorac Surg 22, 535

    Article  PubMed  CAS  Google Scholar 

  17. Harken, DE (1976) Editorial: Circulatory assist devices. Med Instrum 10, 215

    PubMed  CAS  Google Scholar 

  18. Harken DE, Lefemine A A (1960) Myocardial and circulatory assistance by synchronized counterpulsation. Dig 15. Annual Conf Eng Med

    Google Scholar 

  19. Kantrowitz A, Kantrowitz A (1953) Experimental augmentation of coronary flow by retardation of arterial pressure pulse. Surgery 34, 628

    Google Scholar 

  20. Kolff WJ, Akutsu T, Dreyer B, Norton H (1959) Artificial heart in the chest and use of poly— urethane for making hearts, valves and aortas. Trans Am Soc, Artif Intern Organs 5, 298

    Google Scholar 

  21. Kolff WJ and Lawson J (1975) Status of the artificial heart and cardiac assist devices in the United States. Transactions of the American Society for Artificial Internal Organs 21, 160

    Google Scholar 

  22. Kreuzer H, Blanke H, Rentrop P, de Vivie ER, Hellberg K (1977) IACP and ECP in pump failure during acute myocardial infarction. In: The first 24 hours in myocardial infarction. Edited by: Kreuzer H, Blanke H, Rentrop P, de Vivie ER, Hellberg K (eds), p 174, Verlag Gerhard Witzstrock

    Google Scholar 

  23. Lefemine AA, Kosowsky B, Madoff I, Black H, Lewis M (1977) Results and complications of intra—aortic balloon pumping in surgical and medical patients. Amer J Cardiol 40, 416

    Article  PubMed  CAS  Google Scholar 

  24. Litwak RS, Koffsky RM, Jurado RA, Lukban SB, Ortiz AF, Jr, Fischer AP, Sherman JJ, Silvay G, Lajam FA (1976) Use of a left heart assist device after intracardiac surgery: Technique and clinical experience. Ann Thorac Surg 21, 191

    Google Scholar 

  25. Leinbach RC, Goldstein J, Gold HK, Moses JW, Collings MB, Subramanian V (1982) Percutaneous wire—guided balloon pumping. Am J Cardiol 49, 1707– 1710

    Google Scholar 

  26. Martin RS, Moncure AC, Buckley MJ, Austen WC, Akins C, Leinbach RC (1983) Complications of percutaneous intra—aortic balloon insertion. J Thorac Cardiovasc Surg 85,186– 190

    Google Scholar 

  27. Moulopoulos SD, Topaz S, Kolff WL (1962) Diastolic balloon pumping (with carbon dioxide) in aorta: Mechanical assistance to failing circulation. Am Heart J 63, 669

    Google Scholar 

  28. Schenk WG Jr, Delin NA, Camp FA, McDonald KE, Pollack L, Gage A, Chardack WM (1964) Assisted circulation: an experimental evaluation of counterpulsation and left ventricular bypass. Arch Surg 88, 327

    PubMed  Google Scholar 

  29. Soroff HS, Clautier CT, Birtwell WC, Begley LA, Messer JV (1974) External counterpulsation. Management of cardiogenic shock after myocardial infarction. J Amer Med Ass 229,1441– 1450

    Google Scholar 

  30. Unger F (1977) Konstruktion und tierexperimentelle Befunde mit einer neuen Form eines künstlichen Herzens: das Ellipsoidherz. Wien Klin Wochenschr. 89 (Suppl 76) 3

    Google Scholar 

  31. de Vivie RE, Kettler D, Hellberg K, Klaess G, Kontokollias J, Sonntag H (1974) Prevention of heart failure during arterial hypoxemia by means of intraaortic balloon pumping. Resuscitation 3, 214– 248

    Google Scholar 

  32. de Vivie RE, Hellberg K (1977) Clinical results of intraaortic balloon pumping in selected groups of patients. In: Assisted Circulation, Ed F. Unger pp 40–46, Berlin, Heidelberg, New York: Springer-Verlag

    Google Scholar 

  33. Wakabayashi A, Nakamura Y, Murphy KJ, Kubo T, Charney KJ, Connolly JE (1973) Controlled veno—arterial bypass without oxygenation in the treatment of cardiogenic shock. Trans Am Sue Artif Intern Organs 19, 511

    CAS  Google Scholar 

  34. Wolner E (1979) Indications for intraaortic balloon pumping. In: Assisted Circulation, Ed F. Unger pp 47–55, Berlin, Heidelberg, New York: Springer Verlag

    Google Scholar 

  35. Wright PW (1975) External counterpulsation for cardiogenic shock following cardiopulmonary bypass surgery. Amer Heart J 90, 231

    Article  PubMed  CAS  Google Scholar 

  36. Zwart HH, Kralios AC, Eastood N, Kolff WF (1972) Effects of partial and complete unloading of the failing left ventricle by transarterial left heart bypass. J Thorac Cardiovasc Surg 63, 865

    PubMed  CAS  Google Scholar 

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Authors
  1. E. R. De Vivie
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  2. H. Hartung
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  3. K. Hellberg
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  4. K. Neuhaus
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  5. W. Ruschewski
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  6. U. Tebbe
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Editor information

Editors and Affiliations

  1. Medical Clinic III, Department of Cardiology, University of Cologne, Joseph-Stelzmann-Strasse 9, 5000, Cologne 41, Federal Republic of Germany

    H. H. Hilger  & V. Hombach  & 

  2. Cardiovascular Laboratories, The Children’s Hospital of Philadelphia One Children’s Center, 34th Street and Civic Center Bvd, Philadelphia, PA, USA

    W. J. Rashkind

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© 1987 Martinus Nijhoff Publishers, Dordrecht

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De Vivie, E.R., Hartung, H., Hellberg, K., Neuhaus, K., Ruschewski, W., Tebbe, U. (1987). Transient mechanical support of the failing heart. In: Hilger, H.H., Hombach, V., Rashkind, W.J. (eds) Invasive Cardiovascular Therapy. Developments in Cardiovascular Medicine, vol 57. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4293-6_12

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  • DOI: https://doi.org/10.1007/978-94-009-4293-6_12

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-8408-6

  • Online ISBN: 978-94-009-4293-6

  • eBook Packages: Springer Book Archive

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