Superior mesenteric and renal flow patterns during intraortic counterpulsation.

NEW FINDINGS: Visceral ischemia remains one of the majorly feared complications during the use of the intraaortic balloon pump. Employing an animal model, we directly measured the flows at the abdominal level and examined flow patterns during IABP. We show that there is a significant balloon-related reduction in superior mesenteric flow in both early and mid-diastole.

ABSTRACT: A number of previous studies have shown that blood flow in the visceral arteries is altered during IABP treatment. For these reasons, we utilized a porcine model to specifically analyze the flow pattern of blood into the visceral arteries during IABP use. For this purpose, we measured the superior mesenteric, right renal and left renal flows before and during IABP support, using surgically-placed flowmeters surrounding these visceral arteries. The superior mesenteric flow significantly decreased in early diastole (p < 0.001) and in mid diastole (p = 0.003 vs. early diastole) whereas in late diastole it increased again (p < 0.001 vs. mid-diastole). During systole, the flow was not significantly increased, compared to late diastole (p = 0.51) but it was significantly lower than at baseline (both < 0.001). Flows did not differ between right and left kidneys. Perfusion of either kidney did not change significantly at early diastole (p > 0.05) whereas it significantly decreased at mid-diastole (p < 0.001) raising dramatically at late diastole (p < 0.001) with an additional slight increase in systole (p = 0.054). This study provides important insights with regards to abdominal flows during intraortic pump counterpulsation. Furthermore, it supports the need to re-think the balloon design to avoid visceral ischemia during circulatory assistance. This article is protected by copyright. All rights reserved.