title: Is there a place for intra-aortic balloon counterpulsation support in acute right ventricular failure by pressure-overload?
abstract: BACKGROUND
  Most therapeutic strategies for acute right ventricular failure (RVF) by pressure-overload are directed to improve cardiac output and coronary perfusion pressure by vasopressive agents. The eventual role of intra-aortic balloon counterpulsation (IABP) support remains questionable. This study investigates the contribution of IABP for acute RVF by pressure-overload, in comparison with phenylephrine (PE) and norepinephrine (NOR).
  
  
  METHODS
  Acute RVF is induced by fixed pulmonary artery constriction in 6 pigs, pursuing a 50% reduction of cardiac output. Assessment of the treatment interventions included biventricular PV-loop analysis, and continuous measurement of aortic and right coronary artery flow.
  
  
  RESULTS
  Restoration of baseline cardiac output was only observed by administration of NOR (Baseline=3.82±1.52ml/min - RVF=2.03±0.59ml/min - IABP=2.45±0.62ml/min - PE=2.98±0.63ml/min - NOR=3.95±0.73ml/min, p<0.001). NOR had most effect on biventricular contractility (PRSW-slope-RV: IABP +24% - PE +59% - NOR +208%, p<0.001 and PRSW-slope-LV: IABP +36% - PE +53% - NOR +196%, p<0.001), heart rate acceleration (IABP +7% - PE +12% - NOR +51%, p<0.001), and RCA flow (IABP +31% - PE +58% - NOR +180%, p<0.001), concomitant to a higher increase of LV-to-RV pressure ratio (IABP: +7% versus -3%, PE: +36% versus +8%, NOR: +101% versus 42%). The hemodynamic contribution of IABP was limited, unless a modest improvement of LV compliance during PE and NOR infusion.
  
  
  CONCLUSIONS
  In a model of acute pressure-overload RV failure, IABP appears to offer limited hemodynamic benefit. The administration of norepinephrine is most effective to correct systemic output and myocardial perfusion through adding an inotropic and chronotropic effect to systemic vasopression.
authors.affiliation: Department of Cardiac Surgery, Erasme Hospital, Free University of Brussels, Brussels, Belgium; Laboratory of Experimental Cardiac Surgery, Ghent University, Ghent, Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: Vanden Eynden
authors.affiliation: Laboratory of Experimental Cardiac Surgery, Ghent University, Ghent, Belgium.
authors.forename: Gilles
authors.initials: G
authors.lastname: Mets
authors.affiliation: Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium; Laboratory of Experimental Cardiac Surgery, Ghent University, Ghent, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: De Somer
authors.affiliation: Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium; Laboratory of Experimental Cardiac Surgery, Ghent University, Ghent, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: Bouchez
authors.affiliation: Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium; Laboratory of Experimental Cardiac Surgery, Ghent University, Ghent, Belgium. Electronic address: thierry.bove@ugent.be.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bove
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D006333:Heart Failure / Q000503:physiopathology* / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D013552:Swine; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology* / Q000601:surgery*
keywords: Hemodynamics; IABP; Pressure overload; RV failure