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Updated: Oct 1, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Hemodynamic analysis of descending versus ascending aortomyoplasty, and comparison with intra-aortic balloon pump
Gil Bolotin1, Frederik H van der Veen, Roberto Lorusso
1The Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Israel. bolotin@netvision.net.il
Insights
Descending aortomyoplasty significantly boosts coronary blood flow more than ascending aortomyoplasty or intra-aortic balloon pump (IABP). However, only ascending aortomyoplasty effectively reduces afterload.
Area of Science:
- Cardiovascular Surgery
- Hemodynamics
- Medical Devices
Background:
- Intra-aortic balloon pump (IABP) is a standard device for hemodynamic support.
- Aortomyoplasty, both descending and ascending, are alternative surgical techniques.
- These techniques aim to replicate the hemodynamic benefits of IABP.
Purpose of the Study:
- To compare descending and ascending aortomyoplasty.
- To evaluate coronary blood flow augmentation and afterload reduction.
- To compare these effects against intra-aortic balloon pump (IABP) counterpulsation.
Main Methods:
- Twenty-two mongrel dogs were used for the study.
- Procedures included IABP application, descending aortomyoplasty, and ascending aortomyoplasty.
- Left anterior descending (LAD) coronary artery blood flow and left ventricular pressure were monitored.
Main Results:
- Descending aortomyoplasty significantly increased LAD blood flow (27%) compared to ascending aortomyoplasty (19%) and IABP (18%).
- Ascending aortomyoplasty reduced left ventricular end-diastolic pressure by 16%, similar to IABP.
- Descending aortomyoplasty did not achieve significant afterload reduction.
Conclusions:
- Descending aortomyoplasty demonstrates superior coronary blood flow augmentation.
- Ascending aortomyoplasty provides afterload reduction comparable to IABP.
- The choice between techniques depends on the desired hemodynamic effect.
Objective:
Descending and ascending aortomyoplasty are two surgical procedures intended to induce hemodynamic benefits similar to those of the intra-aortic-balloon-pump (IABP). To date, there have been no studies comparing the two surgical techniques. The objective of this study was to compare coronary blood flow augmentation and afterload reduction as produced by descending and ascending aortomyoplasty counterpulsation
Methods:
Twenty-two mongrel dogs (18-35 kg) underwent IABP application (n=7), descending (n=8), or ascending (n=7) aortomyoplasty. Left anterior descending (LAD) coronary artery blood flow was measured using a Transonic Doppler flow probe. Left ventricular pressure as well as aortic pressures proximal and distal to either the aortomyoplasty site or the IABP position were monitored continuously.
Results:
Descending aortomyoplasty induced higher elevation in the LAD blood flow during assisted beats (27% from 10.8+/-4 to 13.8+/-6 ml/min, P<0.001) than that induced by either ascending aortomyoplasty (19% from 11.7+/-5 to 14+/-5 ml/min, P<0.001) or IABP counterpulsation (18% from 8.6+/-3 to 10.2+/-4 ml/min, P<0.001). Conversely, while ascending aortomyoplasty reduced the left ventricular end-diastolic pressure by 16% (from 60+/-18 to 50+/-22 mmHg, P<0.001), similar to the 16% after load reduction achieved by the IABP counterpulsation, descending aortomyoplasty failed to induce afterload reduction.
Conclusions:
Descending aortomyoplasty produces higher coronary blood flow augmentation than either ascending aortomyoplasty or IABP. However, afterload reduction comparable to that achieved by IABP was observed only with ascending aortomyoplasty and not with descending aortomyoplasty.
