Terapie chirurgiche dell’Insufficienza Cardiaca. Contropulsazione aortica. Intra Aortic Balloon Pump.
Then in the early 1960s Moulopoulus et al. from the Cleveland Clinic, developed an experimental prototype of the intra-aortic balloon (IAB) whose inflation and deflation were timed to the cardiac cycle. In 1968 the initial use in clinical practice of the IABP and it`s further improvement was realized resp. continued by A. Kantrowiz`s group.
In its first years, the IABP required surgical insertion and surgical removal with a balloons size of 15 French. In 1979 after subsequent development in IABP technology a dramatic headway with the introduction of a percutaneous IAB with a size of 8,5 to 9,5 French was achieved. This advance made it for even nonsurgical personnel possible, to perform an IAB insertion at the patient’s bedside. In 1985 the first prefolded IAB was developed.
Today continued improvements in IABP technology permit safer use and earlier intervention to provide hemodynamic support. All these progresses have made the IABP a mainstay in the management of ischemic and dysfunctional myocardium.IABP- History
The primary goals of IABP treatment are to increase myocardial oxygen supply and decrease myocardial oxygen demand. Secondary, improvement of cardiac output (CO), ejection fraction (EF), an increase of coronary perfusion pressure, systemic perfusion and a decrease of heart rate, pulmonary capillary wedge pressure and systemic vascular resistance occur.
In particular systolic wall tension uses approximately 30% of myocardial oxygen demand. Wall tension itself is affected by intraventricular pressure, afterload, end-diastolic volume and myocardial wall thickness.
TTI (= tension-time index ), is an important determinant of myocardial oxygen consumption. On the other hand, the integrated pressure difference between the aorta and left ventricle during diastole (DPTI = diastolic pressure time index) represents the myocardial oxygen supply (i.e. hemodynamic correlate of coronary blood flow)