Mechanical Assistance by Intra‐Aortic Balloon Pump Counterpulsation During Reperfusion Increases Coronary Blood Flow and Mitigates the No‐Reflow Phenomenon: An Experimental Study

3rd Department of Cardiology, University of Athens School of Medicine, Greece.
Artificial Organs (Impact Factor: 2.05). 07/2011; 35(9):867-74. DOI: 10.1111/j.1525-1594.2011.01241.x
Source: PubMed


The effects of the intra-aortic balloon pump (IABP) counterpulsation on the extent of myocardial infarction (MI), the no-reflow phenomenon (NRP), and coronary blood flow (CBF) during reperfusion in an ischemia-reperfusion experimental model have not been clarified. Eleven pigs underwent occlusion of the mid left anterior descending coronary artery for 1 h, followed by reperfusion for 2 h. CBF, distal to the occlusion site, was measured. In six experiments, IABP support began 10 min before, and continued throughout reperfusion (IABP Group). Five pigs without IABP support served as controls. At the end of each experiment, the myocardial area at risk (MAR) of infarction and the extent of MI and NRP were measured. Hemodynamic measurements at baseline and during coronary occlusion were similar in both groups. During reperfusion, systolic aortic blood pressure was significantly lower in the IABP Group than in controls. In the IABP Group, CBF reached a peak at 5 min of reperfusion, gradually decreased, but remained higher than at baseline, and significantly higher than in controls throughout the 2 h of reperfusion. In controls, CBF increased significantly above baseline immediately after the onset of reperfusion, then returned to baseline within 90 min. The extent of NRP (37 ± 25% vs. 68 ± 17%, P = 0.047) and MI (39 ± 23% vs. 67 ± 13%, P = 0.036), both expressed as percentage of MAR, was significantly less in the IABP group than in controls. After prolonged myocardial ischemia, IABP assistance started just 10 min before and throughout reperfusion increased CBF and limited infarct size and extent of NRP.

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Available from: Michael J. Bonios, Dec 13, 2015
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    • "In contrast, an area of increasing interest is the use of IABP in patients with persistent ischaemia (PI) after primary PCI for AMI (no-reflow phenomenon). Because PI is thought to be reversible over time (within hours to days), decreasing the workload of the myocardium and increasing coronary blood flow by IABP is suggested to limit the final size of the infarcted territory [8]. "
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    ABSTRACT: Recent evidence questions the role of intra-aortic balloon counterpulsation (IABP) in the treatment of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). An area of increasing interest is the use of IABP for persistent ischaemia (PI). We analysed the use of IABP in patients with AMI complicated by CS or PI. From 2008 to 2010, a total of 4076 patients were admitted to our hospital for primary percutaneous coronary intervention (PCI) for AMI. Out of those, 239 patients received an IABP either because of CS or because of PI. Characteristics and outcome of those patients are investigated. The mean age of the study population was 64 ± 11 years; 75 % were male patients. Of the patients, 63 % had CS and 37 % had PI. Patients with CS had a 30-day mortality rate of 36 %; 1-year mortality was 41 %. Patients with PI had a 30-day mortality rate of 7 %; 1-year mortality was 11 %. Mortality in patients admitted for primary PCI because of AMI complicated by CS is high despite IABP use. Outcome in patients treated with IABP for PI is favourable and mandates further prospective studies.
    Full-text · Article · Oct 2013 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    • "IABPs might be effective for limiting infarct sizes in such cases. Pierrakos et al. showed that during reperfusion, IABPs increased coronary blood flow, and effectively limited infarct size [25]. Our study showed that the proportion of IABP insertions during and after PCI procedures was significantly higher in the LD group than in the RD group. "
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    Full-text · Article · Feb 2012 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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