title: Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial activation.
abstract: BACKGROUND
  We aimed to evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves organ function and reduces endothelial activation in patients undergoing coronary artery bypass graft (CABG).
  
  
  RESULTS
  Five-hundred and one CABG patients were randomized into 2 groups: (Group A n=270) linear cardiopulmonary bypass (CPB); and (Group B n=231) automatic 80 beats/min IABP-induced pulsatile CPB. We evaluated hemodynamic response, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate, renal function (estimated glomerular filtration rate [eGFR], creatinine and any possibility of renal insufficiency or failure), respiratory function and endothelial markers (vascular endothelial growth factor [VEGF] and monocyte chemotactic protein-1 [MCP-1]). IABP, which induced surplus hemodynamic energy, was 21,387 ± 4,262 ergs/cm(3). Group B showed lower chest drainage, transfusions, international normalized ratio, and antithrombin III, together with higher platelets, activated partial thromboplastin time, fibrinogen and D-dimer. Transaminases, bilirubin, amylase, lactate were lower in Group B; there were better results for eGFR in Group B from ICU-arrival to 48 h, resulting in lower creatinine from ICU-arrival to 48 h. The necessity for renal replacement therapy was lower in Group B Stage-3. Group B P(a)O(2)/F(i)O(2) and lung compliance improved with aortic de-clamping on the first day with shorter intubation time. Group B showed lower VEGF and MCP-1.
  
  
  CONCLUSIONS
  Pulsatile flow by IABP improves whole-body perfusion and reduces endothelial activation during CPB.
authors.affiliation: Cardiac Surgery Unit, University of Magna Graecia, Campus “S.Venuta”, Viale Europa, 88100 Catanzaro, Italy. filiberto@live.it
authors.forename: Giuseppe Filiberto
authors.initials: GF
authors.lastname: Serraino
authors.forename: Roberto
authors.initials: R
authors.lastname: Marsico
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musolino
authors.forename: Valeria
authors.initials: V
authors.lastname: Ventura
authors.forename: Elio
authors.initials: E
authors.lastname: Gulletta
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santè
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004730:Endothelium, Vascular / Q000378:metabolism* / Q000503:physiopathology*; D005260:Female; D005342:Fibrinolysis; D005919:Glomerular Filtration Rate; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male
chemical_list: D015415:Biomarkers