A Schachtrupp1, H Wrigge, T Busch, W Buhre, A Weyland. 1. Technical University Aachen, Department of General Surgery, Aachen, Germany. Alexander.Schachtrupp@post.rwth-aachen.de
Abstract
BACKGROUND AND OBJECTIVE: The effects of intra-aortic balloon pumping (IABP) on cerebral perfusion are still a matter of debate. End-diastolic reversal of blood flow in cerebral arteries has been observed in a small number of patients. We prospectively investigated the incidence and the amount of transient cerebral artery blood flow reversal during balloon pumping in patients recovering from cardiac surgery. METHODS: In 23 patients receiving IABP support, blood flow velocities in the right middle cerebral artery were assessed by transcranial Doppler-sonography. Additionally, systemic haemodynamics were monitored. In each patient, measurements were performed at three different pump settings: without support, assist ratio 1 : 1 and assist ratio 1 : 2. RESULTS: In 8 of 23 patients, balloon pumping caused a transient diastolic reversal of blood flow in the middle cerebral artery during balloon deflation. Antegrade mean flow velocity in the middle cerebral artery significantly increased from 57 +/- 27 to 61 +/- 26 (assist ratio 1 : 1) and 61 +/- 29 cm s(-1) (assist ratio 1 : 2) (P < 0.05). Taking transient blood flow reversal into account, net mean flow velocity did not increase with balloon pump support. Systemic haemodynamic parameters remained unchanged. CONCLUSION: Left ventricular support with IABP significantly changed flow patterns in basal cerebral arteries of our patients. In 35% of patients, support resulted in a transient reversal of intracranial blood flow which counterbalanced a slight increase in mean antegrade flow.
BACKGROUND AND OBJECTIVE: The effects of intra-aortic balloon pumping (IABP) on cerebral perfusion are still a matter of debate. End-diastolic reversal of blood flow in cerebral arteries has been observed in a small number of patients. We prospectively investigated the incidence and the amount of transient cerebral artery blood flow reversal during balloon pumping in patients recovering from cardiac surgery. METHODS: In 23 patients receiving IABP support, blood flow velocities in the right middle cerebral artery were assessed by transcranial Doppler-sonography. Additionally, systemic haemodynamics were monitored. In each patient, measurements were performed at three different pump settings: without support, assist ratio 1 : 1 and assist ratio 1 : 2. RESULTS: In 8 of 23 patients, balloon pumping caused a transient diastolic reversal of blood flow in the middle cerebral artery during balloon deflation. Antegrade mean flow velocity in the middle cerebral artery significantly increased from 57 +/- 27 to 61 +/- 26 (assist ratio 1 : 1) and 61 +/- 29 cm s(-1) (assist ratio 1 : 2) (P < 0.05). Taking transient blood flow reversal into account, net mean flow velocity did not increase with balloon pump support. Systemic haemodynamic parameters remained unchanged. CONCLUSION: Left ventricular support with IABP significantly changed flow patterns in basal cerebral arteries of our patients. In 35% of patients, support resulted in a transient reversal of intracranial blood flow which counterbalanced a slight increase in mean antegrade flow.
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