Intraaortic Balloon Pumping Improves Hemodynamics and Right Ventricular Efficiency in Acute Ischemic Right Ventricular Failure

BACKGROUND: Left ventricular unloading has a potentially deleterious effect in right ventricular failure as a result of altered septal interplay. However, a positive effect of an intraaortic balloon pump during right ventricular failure has been suggested. We investigated the impact of intraaortic balloon pumping on hemodynamics and both left and right ventricular function in an experimental model of isolated right ventricular failure.

METHODS: Sixteen anesthetized pigs (25 to 34 kg) were used in an in vivo model. Pressure-conductance catheters assessed right and left ventricular pressure-volume relationships. Acute right ventricular failure was induced by right coronary microembolization, and led to severely impaired right ventricular function, reduced cardiac output and arterial pressure, and an increased pulmonary vascular resistance and pulmonary arterial elastance. Animals were then randomized to balloon pump or control groups and evaluated with respect to hemodynamics and ventricular function after 1 hour.

RESULTS: Intraaortic balloon pumping did not alter right or left ventricular contractility. However, balloon pump–treated animals had significantly improved cardiac output (+18% ± 18% versus –6% ± 7%; p = 0.003) and mean arterial pressure (+36% ± 30% versus –7% ± 14%; p = 0.004) compared with controls. Animals in the balloon pump group had lower pulmonary vascular resistance (795 ± 63 versus 912 ± 259 dynes · sec · cm^–5; p < 0.01) and pulmonary arterial elastance (1.14 ± 0.20 versus 1.69 ± 0.65 mm Hg/mL; p < 0.01), and increased stroke volume (22.3 ± 4.7 versus 17.9 ± 4.7 mL; p = 0.016). Right ventricular efficiency was also improved in the balloon pump group (stroke work per pressure-volume area = 0.60 ± 0.14 versus 0.41 ± 0.12; p < 0.01).

CONCLUSIONS: Intraaortic balloon pump support does not alter right or left ventricular function in acute right ventricular failure. However, arterial pressure, cardiac output, and right ventricular efficiency are improved, possibly because of a balloon pump–induced reduction in pulmonary arterial resistance.