title: Intraaortic counterpulsation during cardiopulmonary bypass impairs distal organ perfusion.
abstract: BACKGROUND
  Recent studies have focused on the use of fixed-rate intraaortic balloon pumping (IABP) during cardiopulmonary bypass (CPB) to achieve pulsatile flow. Because application of an IABP catheter may represent a functional obstruction within the descending aorta, we explored the effect of IABP-pulsed CPB-perfusion with special attention to perfusion above and below the IABP balloon.
  
  
  METHODS
  Sixteen animals received an IABP catheter that remained turned off position (NP group, n = 8) or was switched to an automatic mode of 80 beats/min during CPB (PP group, n = 8). Flow-data and pressure-data were obtained above and below the IABP balloon. Tissue perfusion was evaluated by microspheres.
  
  
  RESULTS
  IABP-pulsed CPB-perfusion, as assessed at 30 minutes on CPB, increased proximal mean aortic pressure (p < 0.05) and carotid artery blood flow (p < 0.001), but decreased distal mean aortic pressure (p < 0.001). The decrease of distal mean aortic pressure in the PP group was associated with a 75 % decrease (p < 0.001) of renal tissue perfusion. During nonpulsed perfusion the respective variables remained essentially unchanged compared with pre-CPB levels.
  
  
  CONCLUSIONS
  Using IABP as a surrogate to achieve pulsatile perfusion during CPB contributes significantly to lowered aortic pressure in the distal portion of aorta and impaired tissue perfusion of the kidneys. The results are focusing on effects that may contribute to organ dysfunction and acute kidney injury. Consequently, assessment of perfusion pressure distal to the balloon should be addressed whenever IABP is used during CPB.
authors.affiliation: Section for Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Lundemoen
authors.affiliation: Section for Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway; Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Venny Lise
authors.initials: VL
authors.lastname: Kvalheim
authors.affiliation: Department of Anesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Øyvind Sverre
authors.initials: ØS
authors.lastname: Svendsen
authors.affiliation: Section for Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Arve
authors.initials: A
authors.lastname: Mongstad
authors.affiliation: Section for Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Knut Sverre
authors.initials: KS
authors.lastname: Andersen
authors.affiliation: Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Ketil
authors.initials: K
authors.lastname: Grong
authors.affiliation: Department of Anesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway; Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway. Electronic address: paul.husby@k1.uib.no.
authors.forename: Paul
authors.initials: P
authors.lastname: Husby
mesh_terms: D000818:Animals; D062186:Arterial Pressure; D002315:Cardiopulmonary Bypass; D015908:Counterpulsation; D005260:Female; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects*; D007432:Intraoperative Period; D008297:Male; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D013552:Swine