Intra-aortic balloon pumping: seven years' experience.

Abstract

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

Predictors of survival in patients requiring IABP support following cardiac surgery

“…According to previous studies, the incidence of IABP use in cardiac surgery ranges between 1.5-17% (Torchiana et al, 1997;Vigneswaran et al, 1985).…”