ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1998 October;39(5):625-32

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

The efficacy of the high volume counterpulsation technique at very low levels of aortic pressure

Charistos Ch. E., Nanas J. N., Kontoyiannis D. A., Nanas S. N., Stamatopoulos G. Z., Rapti A. C., Stamatelopoulos S. F., Moulopoulos S. D.

From the Department of Clinical Therapeutics “Alexandra” Hospital University of Athens, School of Medicine, Athens, Greece

Background. The objec­tive of the ­present study was to iden­ti­fy the hemo­dy­nam­ic var­i­ables, that pre­clude the effec­tive­ness of the coun­ter­pul­sa­tion tech­nique.
Methods. In order to ­achieve high coun­ter­pul­sa­tion vol­ume two devic­es were used simul­ta­ne­ous­ly. The par­a­-aor­tic coun­ter­pul­sa­tion ­device pump­ing 60-70 ml was implant­ed on the ascend­ing aorta, and the intra­aor­tic bal­loon (20 ml) was ­placed in the descend­ing aorta of 14 dogs with ­severe car­di­o­gen­ic shock. Both devic­es were syn­chron­ized to pro­vide aor­tic dia­stol­ic aug­men­ta­tion. The mechan­i­cal assis­tance pro­vid­ed by these devic­es was con­sid­ered ade­quate when the mean aor­tic pres­sure dur­ing the sup­por­tive peri­od was at least 50 mmHg, a pres­sure com­pat­ible with life.
Results. The mechan­i­cal assis­tance pro­vid­ed by the two devic­es was ade­quate in none (0%) of the cases with a sys­tol­ic aor­tic pres­sure below 30 mmHg (Group I), in 71% of the cases with a sys­tol­ic aor­tic pres­sure ­between 30-56 mmHg (Group II), and in 100% of the cases with a sys­tol­ic aor­tic pres­sure above 56 mmHg (Group III). In group II the left ven­tric­u­lar end-dia­stol­ic pres­sure was high­er in the cases respond­ing ade­quate­ly to mechan­i­cal assis­tance (Subgroup IIa) than in the ones where no ade­quate ­response was ­obtained (Subgroup IIb).
Conclusions. The very low lev­els of the sys­tol­ic aor­tic pres­sure was the most impor­tant fac­tor pre­clud­ing the ade­quate effec­tive­ness of the coun­ter­pul­sa­tion tech­nique.