Continuous internal counterpulsation as a bridge to recovery in acute and chronic heart failure

Table 1 Criteria of sufficiency of recovery with easily-explantable counterpulsation devices and continuous flow left ventricular assist devices

Counterpulsation devices
EF	↑ 5%
BNP	< 500 pg/mL
Continuous flow LVADs
LVEDD	< 60 mm
LV end-systolic diameter	< 50 mm
EF	> 45%
LV end-diastolic pressure/PCWP	< 12 mmHg
Cardiac Index (resting)	> 2.8 L/min per square

EF: Ejection fraction; LV: Left ventricular; LVAD: Left ventricular assist device; PCWP: Pulmonary capillary wedge pressure; LVEDD: Left ventricular end-diastolic dimension.

Table 2 Effects of counterpulsation on systemic hemodynamics and left ventricular mechanoenergetics

Decrease

Systolic aortic pressure

End-diastolic aortic pressure

LV systolic wall stress (afterload)

Myocardial oxygen/LV energy consumption

End-diastolic ventricular volume (preload)

Mean pulmonary capillary wedge pressure

Increase

Diastolic aortic pressure (augmentation)

LV mechanical performance (ejection fraction, stroke volume, cardiac output)

LV contractility and active relaxation (in the reperfused failing heart)

Coronary blood flow (post-ischemia, when coronary autoregulation is impaired and flow is pressure-dependent)[33]

Cerebral, renal, mesenteric and pulmonary blood flow

Mean arterial pressure (in patients with shock)

LV: Left ventricular.

Table 3 Potential roles of long-term intra-aortic balloon pump support in chronic heart failure

Improves patients’ clinical status and their hemodynamic indices, rendering them suitable candidates for heart transplantation (BTT)

Improves RV functionality and peripheral organ function, increasing the candidacy rates of patients who are illegible for additional mechanical interventions (BTC)

Enhances native LV functional performance and unloads LV while maintaining its integrity, promoting reverse remodeling and cardiac recovery (BTR)

BTT: Bridge to transplantation; LV: Left ventricular; RV: Right ventricular.