title: Combined Impella and intra-aortic balloon pump support to improve both ventricular unloading and coronary blood flow for myocardial recovery: an experimental study.
abstract: Some patients in need of hemodynamic support do not respond to intra-aortic balloon pump (IABP) therapy. Hemodynamic stability can then be obtained by a more potent cardiac assist device, like the Impella catheter pump. Whether additional IABP support additional to Impella support can provide more optimal hemodynamic myocardial conditions is examined in this study. Seven sheep were implemented with IABP and Impella. An acute myocardial infarction was induced. Hemodynamic performance was assessed during baseline, during Impella support and IABP support individually, and during the combined Impella plus IABP support. The Impella support provided a reduction of afterload with 30% and an increase of coronary artery flow with 47%. The IABP increased coronary artery flow (13%), carotid artery flow (16%), and aortic ascending blood pressure (6%); a similar (but stronger) effect was provided when using the IABP support additional to Impella support and, respectively, increases of 33, 21, and 19% were established. The oxygen demand-supply ratio decreased by 25% due to the extra use of the IABP. A combination of IABP and Impella provides the most optimal hemodynamic myocardial conditions compared to either stand-alone support.
authors.affiliation: Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Academic Hospital Maastricht, Maastricht, The Netherlands. l.sauren@ctc.unimaas.nl
authors.forename: Loes D C
authors.initials: LD
authors.lastname: Sauren
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Accord
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamzeh
authors.forename: Monique
authors.initials: M
authors.lastname: de Jong
authors.forename: Theo
authors.initials: T
authors.lastname: van der Nagel
authors.forename: Frederik H
authors.initials: FH
authors.lastname: van der Veen
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000818:Animals; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000502:physiology*; D004195:Disease Models, Animal; D006353:Heart-Assist Devices; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D009203:Myocardial Infarction / Q000628:therapy*; D010101:Oxygen Consumption / Q000502:physiology; D011897:Random Allocation; D012680:Sensitivity and Specificity; D012756:Sheep; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology