title: Prolonged intra-aortic balloon pump support in biventricular heart failure induces right ventricular reverse remodeling.
abstract: BACKGROUND
  Right ventricular dysfunction is associated with high morbidity and mortality in candidates for left ventricular assist device (LVAD) implantation or cardiac transplantation.
  
  
  METHODS
  We examined the effects of prolonged intra-aortic balloon pump (IABP) support on right ventricular, renal and hepatic functions in patients presenting with end-stage heart failure.
  
  
  RESULTS
  Between March 2008 and June 2013, fifteen patients (mean age = 49.5 years; 14 men) with end-stage systolic heart failure (HF), contraindications for any life saving procedure (conventional cardiac surgery, heart transplantation, LVAD implantation) and right ventricular dysfunction were supported with the IABP. The patients remained on IABP support for a mean of 73 ± 50 days (median 72, range of 13-155). We measured the echocardiographic and hemodynamic changes in right ventricular function, and the changes in serum creatinine and bilirubin concentrations before and during IABP support. Mean right atrial pressure decreased from 12.7 ± 6.5 to 3.8 ± 3.3 (P < 0.001) and pulmonary artery pressure decreased from 35.7 ± 10.6 to 25 ± 8.4 mmHg (P = 0.001), while cardiac index increased from 1.5 ± 0.4 to 2.2 ± 0.7 l/m(2)/min (P = 0.003) and right ventricular stroke work index from 485 ± 228 to 688 ± 237 mmHg × ml/m(2) (P = 0.043). Right ventricular end-diastolic diameter decreased from 34.0 ± 6.5 mm to 27.8 ± 6.2 mm (P < 0.001) and tricuspid annular systolic tissue Doppler velocity increased from 9.6 ± 2.4 cm/s to 11.1 ± 2.3 cm/s (P = 0.029). Serum creatinine and bilirubin decreased from 2.1 ± 1.3 to 1.4 ± 0.6 mg/dl and 2.0 ± 1.0 to 0.9 ± 0.5 mg/dl, respectively (P = 0.002 and P < 0.001, respectively).
  
  
  CONCLUSIONS
  Prolonged IABP support of patients presenting with end-stage heart failure and right ventricular dysfunction induced significant improvement in right ventricular and peripheral organ function.
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ntalianis
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Kapelios
authors.affiliation: Department of Therapeutics, Alexandra Hospital, University of Athens Medical School, Vasilisis Sophias 80, 11 528 Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kanakakis
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Repasos
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pantsios
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Emmeleia
authors.initials: E
authors.lastname: Nana
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Kontogiannis
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Malliaras
authors.affiliation: Department of Cardiac Surgery, Evangelismos Hospital, 45-47 Ypsilantou Street, 10 676 Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Tsamatsoulis
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kaldara
authors.affiliation: Department of Cardiac Surgery, Evangelismos Hospital, 45-47 Ypsilantou Street, 10 676 Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Charitos
authors.affiliation: 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece. Electronic address: inanas@med.uoa.gr.
authors.forename: John N
authors.initials: JN
authors.lastname: Nanas
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000628:therapy*; D016278:Ventricular Function, Right / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D003404:Creatinine; D001663:Bilirubin
keywords: Heart failure; Intra-aortic balloon pump; Left ventricular assist device; Right ventricular dysfunction