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Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial
Giuseppe Filiberto Serraino1, Roberto Marsico, Giuseppe Musolino
1Cardiac Surgery Unit, University of Magna Graecia, Campus “S.Venuta”, Viale Europa, 88100 Catanzaro, Italy. filiberto@live.it
Insights
Intra-aortic balloon pump (IABP) pulsatile cardiopulmonary bypass (CPB) improves organ function and reduces endothelial activation in coronary artery bypass graft (CABG) surgery patients. This study demonstrates better hemodynamic response and reduced organ damage with IABP-assisted CPB.
Area of Science:
- Cardiovascular Surgery
- Cardiopulmonary Bypass
- Medical Devices
Background:
- Coronary artery bypass graft (CABG) surgery often involves cardiopulmonary bypass (CPB).
- Optimizing organ function and minimizing endothelial activation during CPB are critical for patient outcomes.
Purpose of the Study:
- To evaluate the impact of intra-aortic balloon pump (IABP)-assisted pulsatile CPB on organ function and endothelial activation in CABG patients.
- To compare outcomes between standard linear CPB and IABP-induced pulsatile CPB.
Main Methods:
- A randomized trial involving 501 CABG patients comparing linear CPB (Group A) with IABP-induced pulsatile CPB (Group B).
- Assessment of hemodynamic response, coagulation, organ function markers (renal, hepatic, respiratory), and endothelial markers (VEGF, MCP-1).
Main Results:
- IABP-assisted pulsatile CPB (Group B) demonstrated improved hemodynamic energy, reduced chest drainage, and fewer transfusions.
- Group B showed better renal function (higher eGFR, lower creatinine), improved respiratory parameters, and reduced levels of endothelial markers (VEGF, MCP-1).
- Lower rates of renal replacement therapy were observed in Group B.
Conclusions:
- Pulsatile flow generated by IABP during CPB enhances whole-body perfusion.
- IABP-assisted pulsatile CPB significantly reduces endothelial activation and improves organ function in CABG patients.
Background:
We aimed to evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves organ function and reduces endothelial activation in patients undergoing coronary artery bypass graft (CABG).
Methods And Results:
Five-hundred and one CABG patients were randomized into 2 groups: (Group A n=270) linear cardiopulmonary bypass (CPB); and (Group B n=231) automatic 80 beats/min IABP-induced pulsatile CPB. We evaluated hemodynamic response, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate, renal function (estimated glomerular filtration rate [eGFR], creatinine and any possibility of renal insufficiency or failure), respiratory function and endothelial markers (vascular endothelial growth factor [VEGF] and monocyte chemotactic protein-1 [MCP-1]). IABP, which induced surplus hemodynamic energy, was 21,387 ± 4,262 ergs/cm(3). Group B showed lower chest drainage, transfusions, international normalized ratio, and antithrombin III, together with higher platelets, activated partial thromboplastin time, fibrinogen and D-dimer. Transaminases, bilirubin, amylase, lactate were lower in Group B; there were better results for eGFR in Group B from ICU-arrival to 48 h, resulting in lower creatinine from ICU-arrival to 48 h. The necessity for renal replacement therapy was lower in Group B Stage-3. Group B P(a)O(2)/F(i)O(2) and lung compliance improved with aortic de-clamping on the first day with shorter intubation time. Group B showed lower VEGF and MCP-1.
Conclusions:
Pulsatile flow by IABP improves whole-body perfusion and reduces endothelial activation during CPB.
