Prolonged intra-aortic balloon pump support in biventricular heart failure induces right ventricular reverse remodeling

Argyrios Ntalianis; Chris J Kapelios; John Kanakakis; Evangelos Repasos; Christos Pantsios; Emmeleia Nana; Christos Kontogiannis; Konstantinos Malliaras; Michael Tsamatsoulis; Elisabeth Kaldara; Christos Charitos; John N Nanas

doi:10.1016/j.ijcard.2015.05.014

Prolonged intra-aortic balloon pump support in biventricular heart failure induces right ventricular reverse remodeling

Int J Cardiol. 2015 Aug 1:192:3-8. doi: 10.1016/j.ijcard.2015.05.014. Epub 2015 May 8.

Affiliations

¹ 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece.
² Department of Therapeutics, Alexandra Hospital, University of Athens Medical School, Vasilisis Sophias 80, 11 528 Athens, Greece.
³ Department of Cardiac Surgery, Evangelismos Hospital, 45-47 Ypsilantou Street, 10 676 Athens, Greece.
⁴ 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11 527 Athens, Greece. Electronic address: inanas@med.uoa.gr.

PMID: 25981570
DOI: 10.1016/j.ijcard.2015.05.014

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.

Keywords: Heart failure; Intra-aortic balloon pump; Left ventricular assist device; Right ventricular dysfunction.

Publication types

Clinical Trial

MeSH terms

Adult
Bilirubin / blood
Creatinine / blood
Echocardiography
Female
Heart Failure / physiopathology
Heart Failure / therapy*
Hemodynamics
Humans
Intra-Aortic Balloon Pumping*
Kidney Function Tests
Liver Function Tests
Male
Middle Aged
Ventricular Dysfunction, Right / physiopathology
Ventricular Dysfunction, Right / therapy*
Ventricular Function, Right / physiology*
Ventricular Remodeling / physiology*

Substances

Creatinine
Bilirubin