Automatic Intraaortic Balloon Pump Timing Using an Intrabeat Dicrotic Notch Prediction Algorithm Jan J. Schreuder, MD, PhD, Alessandro Castiglioni, MD,

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Presentation transcript:

Automatic Intraaortic Balloon Pump Timing Using an Intrabeat Dicrotic Notch Prediction Algorithm Jan J. Schreuder, MD, PhD, Alessandro Castiglioni, MD, Andrea Donelli, MS, Francesco Maisano, MD, Jos R.C. Jansen, PhD, Ramzi Hanania, MS, Pat Hanlon, RN, Jan Bovelander, CRNA, Ottavio Alfieri, MD The Annals of Thoracic Surgery Volume 79, Issue 3, Pages 1017-1022 (March 2005) DOI: 10.1016/j.athoracsur.2004.07.074 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Examples of aortic pressure (Pao) and real-time derived aortic flow waveforms as calculated by the dicrotic notch prediction algorithm in 2 patients (A and B) with intraaortic balloon pump at 1:4 assist ratio. The Annals of Thoracic Surgery 2005 79, 1017-1022DOI: (10.1016/j.athoracsur.2004.07.074) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Examples of IABP at 1:1 during arrhythmia in patient A (EF 25%) and B (EF 15%) undergoing mitral valve repair. Pressure (P) and volume (V) tracings show accurate automatic intrabeat IABP inflation without signs of too early IAB inflation in the left ventricular (lv) P-V plane. Automatic R-wave IAB deflation is correct in example A and too late in B, however without signs of afterload increase during early ejection in the P-V plane. (EF = ejection fraction; IABP = intraaortic balloon pump; Pao = mean aortic pressure; Piab = intraaortic balloon pressure; PLV = left ventricular pressure; VLV = left ventricular volume.) The Annals of Thoracic Surgery 2005 79, 1017-1022DOI: (10.1016/j.athoracsur.2004.07.074) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Examples of (left) suboptimal and (right) optimal intraaortic balloon pump (IABP) assist in a patient (New York Heart Association functional class III, ejection fraction 15%, undergoing mitral valve reconstruction) during arrhythmia in the pressure-volume (P-V) plane. Although the IAB inflation timing is correct during suboptimal assist, as can be derived from the aortic pressure (Pao) tracing, the IAB inflation episodes are too short and three of nine beats were not assisted. During optimal assist the left ventricular (LV) afterload decreased and stroke volume increased with concomitant decreases in LV end-systolic and end-diastolic volume. (ECG = electrocardiogram; P/v = left ventricular pressure; PIAB = intraaortic balloon pressure; V/v = left ventricular volume.) The Annals of Thoracic Surgery 2005 79, 1017-1022DOI: (10.1016/j.athoracsur.2004.07.074) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions