Intraaortic Balloon Assistance

doi:10.1016/S0003-4975(10)63913-6

The Annals of Thoracic Surgery

Volume 21, Issue 6, June 1976, Pages 487-491

https://doi.org/10.1016/S0003-4975(10)63913-6 Get rights and content

Abstract

Intraaortic balloon (IAB) assistance in 64 patients over 2½ years has resulted in a survival rate of 11% (1 patient) when used alone but 47% when utilized in patients treated surgically (long-term survival, 38% [21 patients]). Patients undergoing coronary artery bypass grafting or aortic valve replacement have a long-term survival of 50% (8 and 9 patients, respectively). The required duration of IAB support has a bearing on the clinical result. Complications have been minimal. Though it was originally developed to assist in the nonoperative management of complications of ischemic heart disease, IAB assistance offers significant promise as an adjuvant to operative therapy for both ischemic and valvular heart disease.

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There are more references available in the full text version of this article.

Cited by (17)

The continuing evolution of mechanical ventricular assistance
1997, Current Problems in Surgery
A great number of patients suffer and die of the sequelae of acute and chronic heart failure each year. Although advances in medical and surgical therapy have benefited many of these patients, most have disease that is refractory to any definitive therapy. For these patients cardiac transplantation is the only remaining hope. Unfortunately, because of the increasing demand for donor organs in the face of a fixed and limited supply, this option is available to only a small percentage of these patients. Even in patients accepted for transplantation, a significant waiting list mortality has been observed.
A variety of VADs have been developed since the first successful case of mechanical cardiac assistance more than 30 years ago. These devices differ in basic mechanical function, method of insertion, and degree of implantability and thus have different indications and potential applications. Whereas the intraaortic balloon pump and centrifugal pumps are effective short-term support modalities, extracorporeal and implantable pulsatile devices have been used successfully for long-term support of patients with reversible and nonreversible cardiac failure. Although these pumps have most commonly been used as bridges to transplantation, increasing clinical experience has supported the notion of long-term mechanical assistance as a definitive therapy for patients with end-stage heart disease.
Although complications, particularly infection and thromboembolism, pose significant challenges and long-term device reliability remains to be fully determined, available implantable devices appear to be capable of providing effective long-term support. As data are obtained from currently ongoing trials comparing VAD support with medical therapy for end-stage heart failure, ethical and economic issues will assume increasing importance.
Intraaortic balloon counterpulsation: Patterns of usage and outcome in cardiac surgery patients
1992, The Annals of Thoracic Surgery
Between January 1, 1986, and May 6, 1991, 7,884 cardiac surgical procedures requiring cardiopulmonary bypass were performed at our institution, including 672 (9.8% of adult procedures) performed in 669 patients that were associated with preoperative (n = 240), intraoperative (n = 353), or postoperative (n = 79) use of an intraaortic balloon pump. The mean age of recipients was 65.3 years (range, 16 to 89 years). Intraaortic balloon pump usage increased during the study period from 6.4% of patients ( $83 / 1,298$ ) in 1986 to 12.7% of patients ( $169 / 1,333$ ) in 1990. The relative distribution between preoperative (mean, 35.7%), intraoperative (52.5%), and postoperative (11.8%) insertion remained nearly constant during the study period. The overall operative (30-day) mortality for patients with preoperative, intraoperative, or postoperative insertion of the intraaortic balloon pump was 19.6%, 32.3%, and 40.5%, respectively (χ² = 16.4; p < 0.001). Although use of the intraaortic balloon pump in the intraoperative and postoperative settings is accompanied by a favorable outcome in most patients, the high associated mortality suggests the need for earlier use of the intraaortic balloon pump or other supportive measures such as the ventricular assist device.
Use of the intra-aortic balloon pump after valve replacement. Predictive indices, correlative parameters, and patient survival
1986, Journal of Thoracic and Cardiovascular Surgery
Intra-aortic balloon pump counterpulsation required as an adjunct during weaning from cardiopulmonary bypass or for circulatory support in the immediate postoperative period was analyzed in 2,498 patients undergoing valve replacement between December, 1972, and September, 1981. A total of 140 successful insertions were performed in 155 attempts. Ninety-five of these patients were from a homogeneous cohort of 1,908 patients undergoing valve replacement with porcine xenografts and were analyzed for factors that might be useful predictors of the need for balloon pump support. Univariate analysis of individual factors delineated preoperative characteristics in patients having mitral valve replacement and intraoperative factors in all patients that correlated with use of the balloon pump. Multivariate analysis revealed a subset of male patients with mitral valve and coronary disease most likely to require counterpulsation. Overall survival rate was markedly reduced at 30 days (balloon counterpulsation plus valve replacement, 50% ±5%; valve replacement only, 96% ± 5%; p < 0.001) and at 1 year (balloon counterpulsation plus valve replacement, 38% ±5%; valve replacement only, 89% ± 1%, p < 0.001) if balloon pumping was required. The entire group of 140 patients were retrospectively analyzed for factors predictive of survival. Patients requiring balloon pumping who had a preoperative diagnosis of aortic regurgitation had a lower 1 year survival rate (13% ±9%) than the total subgroup undergoing balloon counterpulsation (36% ± 4.0%) (p = 0.002). Similarly patients treated by balloon counterpulsation who had postoperative renal failure had a significantly lower 1 year survival rate (17% ±5%) than those without renal failure (66% ± 6%) (p = 0.003). The survival rate of patients who required this therapeutic modality after valve replacement is poor. Other methods of hemodynamic support are necessary.
Intraaortic Balloon Pumping in Cardiac Surgical Patients: A Nine-Year Experience
1983, Annals of Thoracic Surgery
From March, 1973, to April, 1982, 378 of 5,546 patients (6.8%) undergoing cardiac operations had insertion of an intraaortic balloon pump (IABP). The 378 patients ranged in age from 19 to 84 years (mean, 58.2 years) and included 4.7% of patients undergoing coronary bypass grafting and 10.6% of patients undergoing valve replacement. An IABP was inserted preoperatively in 22 patients with unstable angina pectoris and in 33 patients with cardiogenic shock; intraoperatively in 252 patients who could not be weaned from cardiopulmonary bypass; and postoperatively in 71 patients who had hemodynamic deterioration. The IABP was inserted by femoral arteriotomy in 201 patients, by percutaneous femoral puncture in 161 patients, and by transthoracic aortotomy in 16 patients. All patients received daily infusions of low molecular weight dextran without heparin during the IABP period.
Duration of IABP support ranged from 1 to 384 hours (mean, 37.3 hours). Out of 230 patients weaned from the IABP, 202 patients were discharged from the hospital for an overall survival rate of 53.4%. The overall incidence of complications was 11.6%. There were 8 IABP-related deaths (2.1%), which were due to ruptured aorta in 6 patients, aortic dissection in 1 patient, and helium embolus in 1. Survival was higher in patients with insertion by percutaneous femoral puncture (99/161; 61.5%) than in patients with insertion by femoral arteriotomy (99/201; 49.3%) (p < 0.025), and lowest in patients with insertion by transthoracic aortotomy (4/16; 25%) (p < 0.001). However, the incidence of major IABP-related complications was higher in patients with percutaneous insertion (9.9%) than in those with femoral arteriotomy insertion (3.5%) (p < 0.005) due to the higher incidence of aortic rupture and ischemia of the leg. It is likely that differences in survival were related to the severity of ventricular failure rather than to the mode of IABP insertion.
Radionuclide Assessment of Left Ventricular Function in Patients Requiring Intraoperative Balloon Pump Assistance
1982, Annals of Thoracic Surgery
Twenty-three surviving patients who were weaned from cardiopulmonary bypass with intraaortic balloon pump assistance returned for follow-up radionuclide left ventricular (LV) function and thallium 201 perfusion studies at a mean of 23 ± 3 months following operation. It was found that despite profound intraoperative myocardial depression requiring intraaortic balloon assistance, 13 patients had no change (within 10%) in the resting LV ejection fraction compared with the preoperative measurement. Among all 23 patients, there was no difference between mean (± standard error of the mean) preoperative and postoperative resting LV ejection fraction (48 ± 4 vs 46 ± 4%, p = not significant [NS]). Only 11 patients had perioperative myocardial infarction documented by new Q waves in the electrocardiogram, by elevation of creatine kinase–MB fraction, or by defects on thallium 201 imaging not explained by documented myocardial infarction before operation. Overall, postoperative resting LV ejection fraction was not different from the preoperative value in patients with perioperative myocardial infarction (44 ± 7 vs 47 ± 5%, p = NS). Postoperative resting LV ejection fraction rose by ≥ 10% compared with preoperative values in 4 patients (3 with aortic valve replacement), remained within the 10% limit in 9 patients, and fell by ≥ 10% in 10 patients (7 with perioperative myocardial infarction). Only 4 out of 16 patients studied at follow-up with exercise radionuclide studies demonstrated a normal LV response to exercise (≥ 5% increase in LV ejection fraction).
Thus, among survivors requiring intraaortic balloon pump assistance for weaning from cardiopulmonary bypass, LV performance at rest is frequently preserved. In addition, 11 of the 23 patients had evidence of perioperative myocardial infarction, indicating a component of reversible intraoperative LV dysfunction.
The Intraaortic Balloon Pump: An Analysis of Five Years' Experience
1980, Annals of Thoracic Surgery
During a five-year period, 178 patients had the intraaortic balloon pump (IABP) inserted for circulatory support. The IABP was used most frequently as an adjunct for weaning patients from cardiopulmonary bypass. Seventy-seven of 103 patients (75%) were successfully weaned from cardiopulmonary bypass with the IABP, and 36 of them (35%) ultimately survived hospitalization. Other indications for the IABP included circulatory support before cardiac operation (16 patients), operative prophylaxis in high-risk patients (13), and postoperative hemodynamic support (23). Additionally, the IABP was placed in 23 patients who did not undergo cardiac operation.
The incidence of IABP-related complications was significantly less when the IABP was inserted through the ascending aorta (4%) intraoperatively compared with the femoral or iliac artery (25%) (p < 0.05). This was due primarily to vascular complications and groin wound infections that occurred with the femoral or iliac artery approach. IABP-related spinal cord paralysis developed in 3 patients (1.7%).
We conclude that the IABP is an effective support device for treating patients with left ventricular failure particularly when weaning them from cardiopulmonary bypass. However, the risk of complications, including paraplegia, must be carefully weighed when use of the IABP is considered, especially in situations in which its efficacy is less clear.

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Supported in part by US Public Health ServiceGrant no. HL-06312-14.

Presented at the Twenty-second Annual Meeting of the Southern Thoracic Surgical Association, Nov 6-8, 1975, New Orleans, LA.

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Intraaortic Balloon Assistance

Abstract

J Thorac Cardiovasc Surg

Ann Thorac Surg

Am J Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Intra-aortic balloon pump assist for cardiogenic shock after cardiopulmonary bypass

Circulation 47