Ascending versus descending aortic balloon pumping: Organ and myocardial perfusion during ischemia

Background. The ICS-Supracor (Abiomed, Danvers, MA) is a preshaped ascendin g aorta balloon pump. We compared the effects of this catheter with the cla ssical descending intraaortic balloon pump (IABP). The study focused on hem odynamic effects, myocardial blood now in normal and ischemic regions, cere bral perfusion, and peripheral organ perfusion. Methods. We placed a stenosis on the lateral branch of the coronary artery to reduce flow 50% (sheep). Measurements included hemodynamic changes, myoc ardial blood now, and organ flow (colored microspheres) at baseline, after stenosis, during IABP support, and during ICS support. Results. Counterpulsation with the ICS led to a significantly higher peak d iastolic aortic augmentation than with the IABP (IABP, 99 +/- 14 mm Hg; ICS , 140 +/- 29 mm Hg; p = 0.003). There was no significant change in cerebral perfusion or peripheral organ perfusion. Myocardial blood perfusion was si gnificantly increased by the IABP as well as the ICS. This effect was seen in ischemic and nonischemic regions (subendocardial and subepicardial). The ICS improved myocardial blood flow significantly more than the IABP (IABP, 0.65 +/- 0.1 mL/min/g; ICS, 0.94 +/- 0.06 mL/min/g; p = 0.0005). Conclusions. The ICS increases myocardial blood flow in ischemic regions si gnificantly more than the IABP, without impairment of cerebral how. Assessm ent of vascular complications, peripherally and in the ascending aorta, has to await results of clinical trials. (C) 2000 by The Society of Thoracic S urgeons.