Intra‐aortic balloon counterpulsation Clinical experience

Tobias, M. A.; Challen, Peter; Franklin, CE; Phillips, Glenys; Varley, Edith M.

doi:10.1111/j.1365-2044.1979.tb08533.x

Cited by 8 publications

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References 25 publications

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“…The two conditions commonly seen are (a) papillary muscle rupture resulting in acute mitral regurgitation and (b) ventricular septal defect with a large left to right shunt.' [3][4][5][6] (2) Patients with unstable angina, in whom increased coronary blood flow may be sufficient to stabilise a patient with ischaemic myocardium.' [5][6][7][8] In recent years, particularly in the United States, intra-aortic balloon pumping has been used electively in high risk patients undergoing cardiac surgery.…”

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confidence: 99%

“…[3][4][5][6] (2) Patients with unstable angina, in whom increased coronary blood flow may be sufficient to stabilise a patient with ischaemic myocardium.' [5][6][7][8] In recent years, particularly in the United States, intra-aortic balloon pumping has been used electively in high risk patients undergoing cardiac surgery. Balloon pumping is commenced before induction of anaesthesia and continued into the immediate postoperative period.59 10 Although the early use of balloon pumping has been advocated, the trend in Glasgow cardiac units has remained conservative, early operation being preferred.…”

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confidence: 99%

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Intra-aortic balloon pumping: seven years' experience.

Vigneswaran¹,

Reece²,

Davidson³

1985

Thorax

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The indications for intra-aortic balloon pumping vary widely from country to country and from one cardiac surgical unit to another. Its use in Glasgow from 1976 to 1983 in 63 patients has been reviewed. Six of the patients (9.5%) had the intra-aortic balloon inserted before cardiac surgery, 43 (68.2%) at the time of surgery, and 14 (22.2%) in the postoperative period. Of the 63 patients, 11 could not be weaned from cardiopulmonary bypass despite intraaortic balloon pumping, and died in the operating room. A further 35 patients had intra-aortic balloon pumping but died in the immediate postoperative period. Seventeen patients (27%) survived from six weeks to 3.3 years after receiving the support of intra-aortic balloon pumping. There was major morbidity in 11 patients (17%), all of whom developed degrees of ischaemia due to ileofemoral arterial obstruction in the leg in which the balloon was inserted. The conservative use of the method in this centre is reflected in the high mortality of these patients.Intra-aortic balloon counterpulsation is a temporary method of assisting cardiac output by producing inflation and deflation of an elongated balloon in the thoracic aorta. Precise timing produces sequential inflation of the balloon with gas (30-40 ml of helium or carbon dioxide) during diastole and active deflation of the balloon during systole. This raises mean aortic diastolic pressure and lowers the peak aortic systolic pressure. Reduction of systolic pressure lowers the resistance to left ventricular ejection, reducing left ventricular afterload and myocardial consumption. In addition, raising the mean diastolic pressure increases blood flow to the coronary arteries.' This affects the diastolic pressure time index/tension time index or endocardial viability ratio' in a beneficial way and forms the physiological basis for the clinical application of balloon pumping.Intra-aortic balloon pumping is used most effectively as an adjunct for weaning patients with left ventricular dysfunction from cardiopulmonary bypass and in the treatment of a low cardiac output state and refractory hypotension after cardiac surgery. ' -5 There has been widespread use of intra-aortic balloon pumping as a method of temporarily improving the cardiac condition before surgery. The two main

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