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. 1979 Jun;189(6):769–775. doi: 10.1097/00000658-197906000-00014

What Role Should the Intra-aortic Balloon Have in Cardiac Surgery

Joseph M Craver, Joel A Kaplan, Ellis L Jones, John Kopchak, Charles R Hatcher
PMCID: PMC1397237  PMID: 453947

Abstract

Intra-aortic balloon pumping (IABP) to assist the failing circulation has become widely applied and accepted since its introduction in 1968. The elective, preoperative use of IABP for patients undergoing cardiac surgery has now become the controversy. The purposes of this report are to examine our experience with IABP and to determine its appropriate role in high-risk patients. IABP was utilized in 75 of 2333 (3.2%) adult cardiac surgical patients at Emory University Hospital from January 1976 through June 1978. IABP was required for refractory shock following cardiopulmonary bypass (CB) in 53 patients, for preoperative cardiogenic shock after acute myocardial infarction (CSMI) in nine and was electively placed prior to CB in 13. Sixty-two patients (81%) were able to separate from CB with IABP and pharmacologic support and were assisted 24–432 hours (median 64 hours). Fifty-five (73%) were weaned from IABP. Fifty (67%) are hospital survivors; late deaths have occurred in six patients (8%). Hemodynamic effect of IABP was demonstrated by comparison of pumping 1:1 to 1:8 mode in five balloon-dependent patients after CB. IABP was found to decrease systolic blood pressure, left ventricular filling pressure and peripheral resistance (p < .05). It increased diastolic and mean blood pressure, cardiac index and the endocardial viability ratio (p < .05). The post-CB use of IABP resulted in highest salvage when utilized to support failing hearts that required surgery despite recent preoperative infarction or when intraoperative ischemic injury had occurred. Poorest results were in patients with extensive chronic myocardial damage. Except in the case of preoperative cardiogenic shock, it was impossible to establish statistically reliable criteria for patients in whom elective preoperative insertion was found to be necessary. Careful surgical and anesthesia management with good monitoring can be used instead of preoperative IABP in the majority of (if not all) hemodynamically stable patients regardless of risk classification.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beckman C. B., Geha A. S., Hammond G. L., Baue A. E. Results and complications of intraaortic balloon counterpulsation. Ann Thorac Surg. 1977 Dec;24(6):550–559. doi: 10.1016/s0003-4975(10)63456-x. [DOI] [PubMed] [Google Scholar]
  2. Begg F. R., Kooros M. A., Magovern G. J., Kent E. M., Brent L. B., Cushing W. B. The hemodynamics and coronary arteriography patterns during acute myocardial infarction. J Thorac Cardiovasc Surg. 1969 Nov;58(5):647–passim. [PubMed] [Google Scholar]
  3. Bolooki H., Williams W., Thurer R. J., Vargas A., Kaiser G. A., Mack F., Ghahramani A. R. Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery. J Thorac Cardiovasc Surg. 1976 Nov;72(5):756–768. [PubMed] [Google Scholar]
  4. Buckley M. J., Mundth E. D., Daggett W. M., Gold H. K., Leinbach R. C., Austen W. G. Surgical management of ventricular septal defects and mitral regurgitation complicating acute myocardial infarction. Ann Thorac Surg. 1973 Dec;16(6):598–609. doi: 10.1016/s0003-4975(10)65041-2. [DOI] [PubMed] [Google Scholar]
  5. Chatterjee K., Swan H. J., Kaushik V. S., Jobin G., Magnusson P., Forrester J. S. Effects of vasodilator therapy for severe pump failure in acute myocardial infarction on short-term and late prognosis. Circulation. 1976 May;53(5):797–802. doi: 10.1161/01.cir.53.5.797. [DOI] [PubMed] [Google Scholar]
  6. Cohn L. H., Gorlin R., Herman M. V., Collins J. J., Jr Aorto-coronary bypass for acute coronary occlusion. J Thorac Cardiovasc Surg. 1972 Oct;64(4):503–513. [PubMed] [Google Scholar]
  7. Cooper G. N., Jr, Singh A. K., Vargas L. L., Karlson K. E. Preoperative intra-aortic balloon assist in high risk revascularization patients. Am J Surg. 1977 Apr;133(4):463–468. doi: 10.1016/0002-9610(77)90132-5. [DOI] [PubMed] [Google Scholar]
  8. Dunkman W. B., Leinbach R. C., Buckley M. J., Mundth E. D., Kantrowitz A. R., Austen W. G., Sanders C. A. Clinical and hemodynamic results of intraaortic balloon pumping and surgery for cardiogenic shock. Circulation. 1972 Sep;46(3):465–477. doi: 10.1161/01.cir.46.3.465. [DOI] [PubMed] [Google Scholar]
  9. Gold H. K., Leinbach R. C., Sanders C. A., Buckley M. J., Mundth E. D., Austen W. G. Intraaortic balloon pumping for ventricular septal defect or mitral regurgitation complicating acute myocardial infarction. Circulation. 1973 Jun;47(6):1191–1196. doi: 10.1161/01.cir.47.6.1191. [DOI] [PubMed] [Google Scholar]
  10. Goldman B. S., Walker P., Gunstensen J., Scully H. E., Adelman A. G. Intra-aortic balloon pump assist: adjunct to surgery for left ventricular dysfunction. Can J Surg. 1976 Mar;19(2):128–134. [PubMed] [Google Scholar]
  11. Hultgren H. N. Medical versus surgical treatment of unstable angina. Am J Cardiol. 1976 Oct;38(4):479–486. doi: 10.1016/0002-9149(76)90467-7. [DOI] [PubMed] [Google Scholar]
  12. Jones E. L., Douglas J. S., Jr, Craver J. M., King S. B., 3rd, Kaplan J. A., Morgan E. A., Hatcher C. R., Jr Results of coronary revascularization in patients with recent myocardial infarction. J Thorac Cardiovasc Surg. 1978 Oct;76(4):545–551. [PubMed] [Google Scholar]
  13. Kaplan J. A., Dunbar R. W., Jones E. L. Nitroglycerin infusion during coronary-artery surgery. Anesthesiology. 1976 Jul;45(1):14–21. doi: 10.1097/00000542-197607000-00004. [DOI] [PubMed] [Google Scholar]
  14. Maroko P. R., Bernstein E. F., Libby P., DeLaria G. A., Covell J. W., Ross J., Jr, Braunwald E. Effects of intraaortic balloon counterpulsation on the severity of myocardial ischemic injury following acute coronary occlusion. Counterpulsation and myocardial injury. Circulation. 1972 Jun;45(6):1150–1159. doi: 10.1161/01.cir.45.6.1150. [DOI] [PubMed] [Google Scholar]
  15. McIntosh H. D. Indications for coronary arteriography. Circulation. 1977 Jul;56(1):1–1. doi: 10.1161/01.cir.56.1.1. [DOI] [PubMed] [Google Scholar]
  16. Parker F. B., Jr, Neville J. F., Hanson E. L., Webb W. R. Intraaortic balloon counterpulsation and cardiac surgery. Ann Thorac Surg. 1974 Feb;17(2):144–151. doi: 10.1016/s0003-4975(10)65625-1. [DOI] [PubMed] [Google Scholar]
  17. Rosensweig J., Chatterjee S., Merino F. Treatment of acute myocardial infarction by counterpulsation. Experimental rationale and clinical experience. J Thorac Cardiovasc Surg. 1970 Feb;59(2):243–250. [PubMed] [Google Scholar]
  18. Scanlon P. J., Nemickas R., Moran J. F., Talano J. V., Amirparviz F., Pifarre R. Accelerated angina pectoris. Clinical, hemodynamic, arteriographic, and therapeutic experience in 85 patients. Circulation. 1973 Jan;47(1):19–26. doi: 10.1161/01.cir.47.1.19. [DOI] [PubMed] [Google Scholar]
  19. Stewart S., Biddle T., DeWeese J. Support of the myocardium with intra-aortic balloon counterpulsation following cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1976 Jul;72(1):109–114. [PubMed] [Google Scholar]
  20. Webb W. R. Editorial: Intraaortic balloon pumping. Ann Thorac Surg. 1976 Jun;21(6):571–572. doi: 10.1016/s0003-4975(10)63934-3. [DOI] [PubMed] [Google Scholar]
  21. Weintraub R. M., Voukydis P. C., Aroesty J. M., Cohen S. I., Ford P., Kurland G. S., LaRaia P. J., Morkin E., Paulin S. Treatment of preinfarction angina with intraaortic balloon counterpulsation and surgery. Am J Cardiol. 1974 Dec;34(7):809–814. doi: 10.1016/0002-9149(74)90701-2. [DOI] [PubMed] [Google Scholar]

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