THE EFFECTS OF INTRA-AORTIC BALLOON PUMP DURING CARDIOPLEGIC ARREST AT DIFFERENT FREQUENCIES OF COUNTERPULSATION

Background. Pulsatile flow during cardioplegic arrest induced by intraaortic balloon pumping (IABP) is considered a potential mechanism of whole-body protection in patient undergoing cardiopulmonary bypass (CPB). We evaluated differences in organ function and endothelial activation in patients undergoing coronary artery bypass graft (CABG), at different frequencies of counterpulsation (at 60, 80 or 100 bpm) during cardioplegic arrest. Methods. Seventy-five patients with CAD undergoing preoperative IABP were randomized between February 2013 and March 2014 to receive pulsatile cardiopulmonary bypass with IABP during cardioplegic arrest at 60 bpm (25 patients; group A), at 80 bpm (25 patients; Group B) and at 100 bpm (25 patients; Group C). Hospital outcome, need for noninvasive ventilation, renal function, transaminase, bilirubin, lactate, and endothelial markers (vascular endothelial growt factor [VEGF] and monocyte chemotactic protein [MCP-1]) were investigated. Results. There were no hospital deaths, no IABP-related complications, and no differences in postoperative noninvasive ventilation (p=NS). Intensive care and hospital stay were comparable (p=NS). Group C showed lower creatine on the first (p=0.01) and second (p=0.005) postoperative days, higher creatinine clearance (first day: p=0.01), lower lactate after CPB termination (p=0.0001) and during the first day (p=0.001). The ALT, AST, and AMY were lower in group C (first day ALT: p=0.03; AST: p=0.03; AMY: p=0.02; second day ALT: p=0.01; AST: p=0.04; AMY: p=0.01), as well as total bilirubin (first day: p=0.043; second day: p=0.031). Group B showed lower VEGF and MCP-1 concentrations at the ICU arrival (p<0.001). Conclusions. Automatic 100 bpm IABP during cardioplegic arrest improves creatinine clearance and splanchnic enzymes. There is evidence that the high frequency counterpulsation can be protective for the whole body-perfusion, if there are no other contraindications.