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J Thorac Cardiovasc Surg 1999;117:164-171
© 1999 Mosby, Inc.

CARDIOPULMONARY SUPPORT AND PHYSIOLOGY

VENTRICULOARTERIAL COUPLING WITH INTRA-AORTIC BALLOON PUMP IN ACUTE ISCHEMIC HEART FAILURE

From the Department of Surgery, Division of Cardiothoracic Surgery, College of Medicine, The Pennsylvania State University, The Milton S. Hershey Medical Center, Hershey, Pa,^a and the Department of Surgery, Jewish Hospital, St Louis, Mo.^b

Received for publication Feb 19, 1998. Revisions requested March 24, 1998. Revisions received May 20, 1998. Accepted for publication Aug 6, 1998. Address for reprints: William S. Pierce, MD, Director, Office of Surgical Research, Associate Chairman, Department of Surgery, The Milton S. Hershey Medical Center, The Pennsylvania State University, PO Box 850, Hershey, PA 17033.

Purpose: We analyzed the mechanism of effects of intra-aortic balloon pumping using the pressure-volume relationship and ventriculoarterial coupling in the normal and failing hearts.
Materials: In 12 anesthetized Holstein calves (weight, 94 ± 8 kg), the ventricular end-systolic and arterial elastances, pressure-volume area, and external work were analyzed during steady-state contractions with traditional hemodynamic parameters with intra-aortic balloon pumping–off and –on (1:1 synchronous ratio). An acute ischemic heart failure was induced by injecting 10 µm microspheres (4.2 ± 1.8 x 10⁷ · 100g left ventricular weight^–1) into the left main coronary artery; all measurements were repeated.
Results: Intra-aortic balloon pumping did not change hemodynamic parameters in the control. However, during heart failure, intra-aortic balloon pumping decreased the arterial elastance from 3.6 ± 1.3 mm Hg to 2.9 ± 1.2 mm Hg · mL^–1 while not affecting the ventricular end-systolic elastance, this resulted in an improvement of the ventriculoarterial coupling ratio from 3.1 ± 0.8 to 2.3 ± 0.8. Intra-aortic balloon pumping decreased not only end-systolic pressure (from 69 ± 16 mm Hg to 64 ± 19 mm Hg) but end-diastolic volume and pressure (from 139 ± 38 mL to 137 ± 37 mL and from 13.9 mm Hg to 12.8 mm Hg, respectively) with the leftward shift of the pressure-volume loop. Pressure-volume area decreased (from 914 ± 284 mm Hg to 849 ± 278 mm Hg · mL) although stroke volume increased (from 21 ± 6 mL to 24 ± 6 mL).
Conclusion: Reduction of the arterial elastance with intra-aortic balloon pumping improved the ventriculoarterial coupling ratio and increased stroke volume. Leftward shift of the pressure-volume loop resulted in the reduction of pressure-volume area, which suggests the conservation of the myocardial oxygen consumption.

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