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Intraaortic Balloon Pump Counterpulsation

  • John Parker Gott

Abstract

Intraaortic balloon pump (IABP) counterpulsation is most frequently used in patients undergoing cardiac operation to increase the likelihood of success in the face of marginal hemodynamics or frank circulatory failure. Balloon counterpulsation is a two-edged sword, however, with the potential for great therapeutic benefit as well as significant morbidity. While clearly efficacious, as evidenced by its low therapeutic index, the IABP must be clearly and compellingly indicated, and impeccable placement technique is crucial, particularly in those patients known to be at increased risk for IABP-related complications. Successful strategies to increase the margin of safety for balloon counterpulsation continue to evolve, and the balloon pump should retain, for the foreseeable future, a vital intermediary position in the therapeutic armamentarium for postcardiotomy pump failure. When pharmacologic measures are not sufficient, and total mechanical support is neither necessary nor feasible, the balloon pump may be lifesaving.

Keywords

Cardiogenic Shock Coronary Blood Flow Mechanical Circulatory Support Intraaortic Balloon Intraaortic Balloon Pump 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Kantrowitz A, Kantrowitz A. Experimental augmentation of coronary flow by retardation of the arterial pressure pulse. Surgery 1953; 34: 678–687.PubMedGoogle Scholar
  2. 2.
    Clauss RH, Birtwell WC, Albertal G, et al. Assisted circulation. I. The arterial counterpulsator. J Thorac Cardiovasc Surg 1961; 41: 447–458.PubMedGoogle Scholar
  3. 3.
    Kantrowitz A, Akutsu T, Chaptal P-A, et al. A clinical experience with an implanted mechanical auxiliary ventricle. JAMA 1966; 197: 525–529.PubMedCrossRefGoogle Scholar
  4. 4.
    Sugg WL, Rea, MJ, Webb WR, et al. Cardiac assistance (counter pulsation) in ten patients. Ann Thorac Surg 1970; 9: 1–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Moulopoulos SD, Topaz S, Kolff WJ. Diastolic balloon pumping (with carbon dioxide) in the aorta-a mechanical assistance to the failing circulation. Am Heart J 1962; 63: 669–675.PubMedCrossRefGoogle Scholar
  6. 6.
    Clauss RH, Missier P, Reed GE, et al. Assisted circulation by counter-pulsation with an intraaortic balloon. Methods and effects. In: Digest, 15th Annual Conference on Engineering in Medicine and Biology. Chicago: Northwestern University; 1962; 4: 44.Google Scholar
  7. 7.
    Kantrowitz A, Tjonneland S, Freed PS, et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA 1968; 203: 135–140.CrossRefGoogle Scholar
  8. 8.
    Kantrowitz A, Krakauer JS, Rosenbaum A, et al. Phase-shift balloon pumping in medically refractory cardiogenic shock: results in 27 patients. Arch Surg 1969; 99: 739–743.PubMedGoogle Scholar
  9. 9.
    Buckley MJ, Leinbach RC, Kastor JA, et al. Hemodynamic evaluation of intraaortic balloon pumping in man. Circulation 1970; 46 (suppl 2): 130–134.Google Scholar
  10. 10.
    Bregman D, Kripke DC, Goetz RH. The effect of synchronous unidirectional intraaortic balloon pumping on hemodynamics and coronary blood flow in cardiogenic shock. Trans Am Soc Artif Intern Organs 1970; 16: 439–446.PubMedGoogle Scholar
  11. 11.
    Scheidt S, Wilner G, Mueller H, et al. Intra-aortic balloon counterpulsation in cardiogenic shock. Report of a cooperative clinical trial. NEngl JMed 1973; 288: 979–984.CrossRefGoogle Scholar
  12. 12.
    Kantrowitz A. Origins of intraaortic balloon pumping. Ann Thorac Surg 1990; 50: 672–674.PubMedCrossRefGoogle Scholar
  13. 13.
    Kantrowitz A. A moment in history: introduction of left ventricular assistance. Trans Am Soc Artif Intern Organs 1987; 19: 39–47.Google Scholar
  14. 14.
    Zelano JA, Ko W, Lazzaro R, et al. Comparison of an extra-aortic counterpulsation device versus intraaortic balloon pumping in severe cardiac failure. Trans Am Soc Artif Int Organs 1991; 37: M342–344.Google Scholar
  15. 15.
    Zelano JA, Ko W, Lazzaro R, et al. Evaluation of an extra-aortic counterpulsation device in severe cardiac failure. Ann Thorac Surg 1992; 53: 30–37.PubMedCrossRefGoogle Scholar
  16. 16.
    Schilt W, Freed PS, Khalil G, et al. Temporary nonsurgical intraarterial cardiac assistance. Trans Am Soc Artif Int Organs 1967; 13: 322–327.Google Scholar
  17. 17.
    Leinbach RC, Gold HK, Buckley MJ, et al. Reduction of myocardial injury during acute infarction by early application of intraaortic balloon pumping and propranolol. Circulation 1973(suppl 4); 47–48: 100.Google Scholar
  18. 18.
    Laird JD, Madras PN, Jones RT et al. Theoretical and experimental analysis of the intraaortic balloon pump. Trans Am Soc Artif Int Organs 1968; 14: 338–343.Google Scholar
  19. 19.
    Weber KT, Janicki JS, Walker AA. Intraaortic balloon pumping: an analysis of several variables affecting balloon performance. Trans Am Soc Artif Intern Organs 1972; 18: 486–495.PubMedGoogle Scholar
  20. 20.
    Weber KT, Janicki JS. Intraaortic balloon counterpulsa tion. A review of physiologic principles, clinical results, and device safety. Ann Thorac Surg 1974; 17: 602–636.PubMedCrossRefGoogle Scholar
  21. 21.
    Sun Y. Modeling the dynamic interaction between left ventricle and intraaortic balloon pump. Am JPhysiol 1991; 261: H1300–H1311.Google Scholar
  22. 22.
    Mountcastle VB, ed. Medical Physiology. St Louis: CV Mosby; 1974: 999.Google Scholar
  23. 23.
    Katz ES, Tunick PA, Kronzon I. Observations of coronary flow augmentation and balloon function during intraaortic balloon counterpulsation using transesophageal echocardiography. Am J Cardiol 1992; 69: 1635–1639.PubMedCrossRefGoogle Scholar
  24. 24.
    Evans JM, McGinnis GE, Brown BG, et al. Development of an intraaortic balloon assist device. Artificial Heart Program Conference Proceedings 1969; 515–528.Google Scholar
  25. 25.
    Roy AJ, Lambert PB, Frank HA, et al. Immediate responses of collateral vessels to abrupt arterial occlusion. Am JPhysio11964; 206: 1299–1303.Google Scholar
  26. 26.
    John HT, Warren R. The stimulus to collateral circulation. Surgery 1961; 49: 14–25.PubMedGoogle Scholar
  27. 27.
    Watson JT, Willerson JT, Fixler DE, et al. Temporal changes in collateral coronary blood flow in ischemic myocardium during intraaortic balloon pumping. Circulation 1973(suppl 4); 47–48: 100.Google Scholar
  28. 28.
    Mueller H, Ayres SM, Giannelli S, et al. Effect of isoproterenol, 1-norepinephrine, and intraaortic counterpulsation on hemodynamics and myocardial metabolism in shock following acute myocardial infarction. Circulation 1972; 45: 335–351.PubMedGoogle Scholar
  29. 29.
    Ehrich DA, Biddle TL, Kronenberg MW, et al. The hemodynamic response to intraaortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction. Am Heart J 1977; 93: 274–279.PubMedCrossRefGoogle Scholar
  30. 30.
    Bardet J, Masquet C, Kahn J-C, et al. Clinical and hemodynamic results of intraaortic balloon counterpulsation and surgery for cardiogenic shock. Am Heart J 1977; 93: 280–288.PubMedCrossRefGoogle Scholar
  31. 31.
    Lazar JM, Ziady GM, Drummer SJ, et al. Outcome and complications of prolonged intraaortic balloon counter-pulsation in cardiac patients. Am J Cardiol 1992; 69: 955–958.PubMedCrossRefGoogle Scholar
  32. 32.
    Fuchs RM, Brin KP, Brinker JA, et al. Augmentation of regional coronary blood flow by intraaortic balloon counter-pulsation in patients with unstable angina. Circulation 1983; 68: 117–123.PubMedCrossRefGoogle Scholar
  33. 33.
    Craver JM, Kaplan JA, Jones EL, et al. What role should the intraaortic balloon have in cardiac surgery? Ann Surg 1979; 189: 769–776.PubMedCrossRefGoogle Scholar
  34. 34.
    Martin TD, Craver JM, Gott JP, et al. A prospective randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. Ann Thorac Surg 1994;57:298–302; discussion 302–304.Google Scholar
  35. 35.
    Georgeson S, Coombs AT, Eckman MH. Prophylactic use of the intraaortic balloon pump in high-risk cardiac patients undergoing noncardiac surgery: a decision analytic view. Am J Med 1992; 92: 665–678.PubMedCrossRefGoogle Scholar
  36. 36.
    Sin SC, Kowalchuk GJ, Welty FK, et al. Intraaortic balloon counterpulsation support in the high-risk cardiac patient undergoing urgent noncardiac surgery. Chest 1991; 99: 13421–345.Google Scholar
  37. 37.
    Dembitsky WP, Moore CH, Holman WL, et al. Successful mechanical circulatory support for non-coronary shock. J Heart Lung Transplant 1992; 11: 129–135.PubMedGoogle Scholar
  38. 38.
    Frazier OH, Nakatani T, Lammermeier DE, et al. Cardiac transplantation and mechanical circulatory assistance: the Texas Heart Institute experience. J Jpn Assoc Thorac Surg 1989; 37: 1873–1879.Google Scholar
  39. 39.
    Marks JD, Karwande SV, Richenbacher WE, et al. Perioperative mechanical circulatory support for transplantation. J Heart Lung Transplant 1992; 11: 117–128.PubMedGoogle Scholar
  40. 40.
    Oaks TE, Wisman CB, Pac WE, et al. Results of mechanical circulatory assistance before heart transplantation. J Heart Transplant 1989; 8: 113–115.PubMedGoogle Scholar
  41. 41.
    Lonquist JL, Duncan JM, Frazier OH, et al. Heart trans plantation after mechanical circulatory support: four years’ experience. J Heart Lung Transplant 1992; 11: 240–245.PubMedGoogle Scholar
  42. 42.
    Kanter KR, Pennington DG, McBride LR, et al. Mechanical circulatory assistance after heart transplantation. J Heart Transplant 1987; 6: 150–154.PubMedGoogle Scholar
  43. 43.
    Symbas P. Cardiothoracic Trauma. Philadelphia: WB Saunders Co; 1989: 55.Google Scholar
  44. 44.
    Beckman CB, Geha AS, Hammond GL, et al. Results and complications of intraaortic balloon counterpulsation. Ann Thorac Surg 1977; 24: 550–559.PubMedCrossRefGoogle Scholar
  45. 45.
    Pollock JC, Charlton MC, Williams WG, et al. Intraaortic balloon pumping in children. Ann Thorac Surg 1980; 29: 522–528.PubMedCrossRefGoogle Scholar
  46. 46.
    Webster H, Veasy LG. Intraaortic balloon pumping in chil dren. Heart Lung 1985; 14: 548–555.PubMedGoogle Scholar
  47. 47.
    Kreidich I, Davies DW, Lim R, et al. High-risk coronary an gioplasty with elective intraaortic balloon pump support. Int J Cardiol 1992; 35: 147–152.CrossRefGoogle Scholar
  48. 48.
    McEnany MI, Kay HR, Buckley MJ, et al. Clinical experience with intraaortic balloon pump support in 728 patients. Circulation 1978; 58 (suppl 1): 124–132.Google Scholar
  49. 49.
    Iverson LIG, Herfindahl G, Ecker RR, et al. Vascular com plications of intraaortic balloon counterpulsation. Am J Surg 1987; 154: 99–103.PubMedCrossRefGoogle Scholar
  50. 50.
    Bregman D, Casaretta WJ. Percutaneous intraaortic balloon counterpulsation for right ventricular failure. J Thorac Cardiovasc Surg 1983; 86: 364–372.Google Scholar
  51. 51.
    Meldrum-Hanna WG, Deal CW, Ross DE. Complications of ascending aortic intraaortic balloon pump cannulation. Ann Thorac Surg 1985; 40: 241–244.PubMedCrossRefGoogle Scholar
  52. 52.
    O’Rourke MF, Shepart KM. Protection of the aortic arch and subclavian artery during intraaortic balloon pumping. J Thorac Cardiovasc Surg 1973; 65: 543–546.PubMedGoogle Scholar
  53. 53.
    LaMuraglia, Vlahakes GJ, Moncure AC, et al. The safety of intraaortic balloon pump catheter insertion through suprainguinal prosthetic vascular bypass grafts. J Vasc Surg 1991; 13: 830–837.PubMedCrossRefGoogle Scholar
  54. 54.
    Phillips SJ, Tannenbaum M, Zeff RH, et al. Sheathless in sertion of the percutaneous intraaortic balloon pump: an alternate method. Ann Thorac Surg 1992; 53: 162.PubMedCrossRefGoogle Scholar
  55. 55.
    Satoh H, Kobayashi T, Hiraishi T, et al. New side-holed sheath for intraaortic balloon pumping to maintain limb perfusion. Ann Thorac Surg 1992; 54: 794–796.PubMedCrossRefGoogle Scholar
  56. 56.
    Grayzel J. Clinical evolution of the Percor percutaneous in traaortic balloon: cooperative study of 722 cases. Circulation 1982; 66 (suppl 1): 223–226.Google Scholar
  57. 57.
    Martin RS, Moncure AC, Buckley MJ, et al. Complications of percutaneous intraaortic balloon insertion. J Thorac Cardiovasc Surg 1983; 85: 186–190.PubMedGoogle Scholar
  58. 58.
    Gottlieb SO, Brinker JA, Borkon AM, et al. Identification of patients at high risk for complications of intraaortic balloon counterpulsation: a multivariate risk factor analysis. Am J Cardiol 1984; 53: 1135–1139.PubMedCrossRefGoogle Scholar
  59. 59.
    Kaplan LJ, Weiman DS, Langan N, et al. Safe intraaortic balloon pump placement through the ascending aorta using transesophageal ultrasound. Ann Thorac Surg 1992; 54: 374–375.PubMedCrossRefGoogle Scholar
  60. 60.
    Baciewicz FA, Kaplan BM, Murphy TE, et al. Bilateral renal artery thrombotic occlusion: a unique complication following removal of a transthoracic intraaortic balloon. Ann Thorac Surg 1982; 33: 631–634.PubMedCrossRefGoogle Scholar
  61. 61.
    Mayer JH. Subclavian artery approach for insertion of intraaortic balloon. J Thorac Cardiovasc Surg 1978; 76: 61–63.PubMedGoogle Scholar
  62. 62.
    McBride LR, Miller LW, Naunheim KS, et al. Axillary artery insertion of an intraaortic balloon pump. Ann Thorac Surg 1989; 48: 874–875.PubMedCrossRefGoogle Scholar
  63. 63.
    Hoka S, Tashiro T, Haruta Y, et al. Modified application of intraaortic balloon pump after repair of thoracic dissecting aneurysm. J Cardiovasc Surg 1992; 33: 41–43.Google Scholar
  64. 64.
    Pappas G. Intrathoracic intraaortic balloon insertion for pulsatile cardiopulmonary bypass. Arch Surg 1974; 109: 842–843.PubMedGoogle Scholar
  65. 65.
    Mavroudis C. To pulse or not to pulse. Ann Thorac Surg1978;25:259–271.PubMedCrossRefGoogle Scholar
  66. 66.
    Miller DC, Moreno-Cabral RI, Applebaum RE, et al. Pulmonary artery balloon counterpulsation for right ventricular failure. Ann Thorac Surg 1984; 37: 167–168.CrossRefGoogle Scholar
  67. 67.
    Symbas PN, McKeown PP, Sanfora AH, et al. Pulmonary artery counterpulsation for treatment of intraoperative right ventricular failure. Ann Thorac Surg 1985; 39: 437–440.PubMedCrossRefGoogle Scholar
  68. 68.
    Skillington PD, Couper GS, Peigh PS, et al. Pulmonary artery balloon counterpulsation for intraoperative right ven tricular failure. Ann Thorac Surg 1991; 51: 658–660.PubMedCrossRefGoogle Scholar
  69. 69.
    Jett GK, Siwek LG, Picone AL, et al. Pulmonary artery balloon pumping: initial clinical experience. Ann Thorac Surg1980; 29: 153–155.CrossRefGoogle Scholar
  70. 70.
    Spence PA, Weisel RD, Easdown J, et al. The hemodynamic effects and mechanism of action of pulmonary artery balloon counterpulsation in the treatment of right ventricular failure during left heart bypass. Ann Thorac Surg 1985; 39: 329–335.PubMedCrossRefGoogle Scholar
  71. 71.
    Mangano DT, Siliciano D, Hollenbert M, et al. Postoperative myocardial ischemia: therapeutic trials using intensive analgesia following surgery. Anesthesiology 1992; 76: 342–353.PubMedCrossRefGoogle Scholar
  72. 72.
    Grounds RM, Lalor JM, Lumley J, et al. Propofol infusion for sedation in the intensive care unit. Preliminary report. Br Med J 1987; 294: 397–400.CrossRefGoogle Scholar
  73. 73.
    Mayumi H, Tokvnaga K. Constant intravenous infusion of chlorpromazine for both sedation and after load reduction in postcardiotomy patients under intraaortic balloon pumping Jpn Heart J 1992; 33: 61–71.PubMedCrossRefGoogle Scholar
  74. 74.
    Goldberg MJ, Rubenfire M, Kantrowitz A, et al. Intraaortic balloon pump insertion: a randomized study comparing percutaneous and surgical techniques. JAm Coll Cardiol 1987; 9: 515–523.CrossRefGoogle Scholar
  75. 75.
    Shahian DM, Neptune WB, Ellis FH, et al. Intraaortic balloon pump morbidity: a comparative analysis of risk factors between percutaneous and surgical techniques. Ann Thorac Surg 1983; 36: 644–653.PubMedCrossRefGoogle Scholar
  76. 76.
    Wasfie T, Freed PS, Rubenfire M, et al. Risks associated with intraaortic balloon pumping in patients with and without diabetes mellitus. Am J Cardiol 1988; 61: 558–562.PubMedCrossRefGoogle Scholar
  77. 77.
    Sisto DA, Hoffman DM, Fernandes S, et al. Is the balloon pump in octogenarians justified? Ann Thorac Surg 1992; 54: 507–511.PubMedCrossRefGoogle Scholar
  78. 78.
    Glenville B, Crockett JR, Bennett JG. Compartment syndrome and intraaortic balloon. Thorac Cardiovasc Surg 1986; 34: 292–294.PubMedCrossRefGoogle Scholar
  79. 79.
    Grantham RN, Munnell ER, Kanaly PJ. Femoral artery infection complicating intraaortic balloon pumping. Am J Surg 1983; 146: 811–814.PubMedCrossRefGoogle Scholar
  80. 80.
    Rajani R, Keon WJ, Bedard P. Rupture of an intraaortic balloon. A case report. J Thorac Cardiovasc Surg 1980; 79: 301–302.PubMedGoogle Scholar
  81. 81.
    Haykal HA, Wang AM. Cardiothoracic diagnosis of delayed cerebral air embolism following intraaortic balloon catheter insertion. Comput Radio11986; 10: 307–309.CrossRefGoogle Scholar
  82. 82.
    Furman S, Vijaynagar R, Rosenbaum R, et al. Lethal sequelae of intraaortic balloon rupture. Surgery 1971; 69: 121–129.PubMedGoogle Scholar
  83. 83.
    Scott IR, Goiti JJ. Late paraplegia as a consequence of intraaortic balloon pump support. Ann Thorac Surg 1985; 40: 300–301.PubMedCrossRefGoogle Scholar
  84. 84.
    Seifert PE, Silverman NA. Late paraplegia resulting from intraaortic balloon pump. Ann Thorac Surg 1986; 41: 700 (letter).Google Scholar
  85. 85.
    Harris RE, Reimer KA, Crain BJ, et al. Spinal cord infarction following intraaortic balloon support. Ann Thorac Surg 1986; 42: 206–207.PubMedCrossRefGoogle Scholar
  86. 86.
    Johnson SA, Scalon PJ, Loeb HS, et al. Treatment of cardiogenic shock in myocardial infarction by intraaortic balloon counterpulsation and surgery. Am JMed 1977; 62: 687–692.Google Scholar
  87. 87.
    Hagemeijer F, Laird J, Haalebos MMP, et al. Effectiveness of intraaortic balloon pumping without cardiac surgery for patients with severe heart failure secondary to a recent myocardial infarction. Am J Caridol 1977; 40: 951–956.CrossRefGoogle Scholar
  88. 88.
    Lorente P, Gourgon R, Beaufils P, et al. Multivariate statistical evaluation of intraaortic counterpulsation in pump failure complicating acute myocardial infarction. Am J Cardiol 1980; 46: 124–134.PubMedCrossRefGoogle Scholar
  89. 89.
    Bavin TK, Self MA. Weaning from intra-aortic balloon pump support. Am JNurs 1991; 10: 54–59.Google Scholar
  90. 90.
    Quaal SJ. Comprehensive Intra-aortic Balloon Pumping. St Louis: The CV Mosby Company; 1984.Google Scholar
  91. 91.
    Brown BG, Goldfarb D, Gott VL. A vasomotor reflex contribution to systolic pressure reduction during diastolic augmentation. Trans Am Soc Artif Int Organs 1966; 12: 63–68.Google Scholar
  92. 92.
    Rohrer MJ, Sullivan CA, McLaughlin DJ, et al. A prospective randomized study comparing surgical and percutaneous removal of intraaortic balloon pump. J Thorac Cardiovasc Surg 1992; 103: 569–572.PubMedGoogle Scholar
  93. 93.
    Brown BG, Gundel WD, McGinnis GE, et al. Improved balloon diastolic augmentation with a double balloon catheter in the ascending and the descending thoracic aorta. Ann Thorac Surg 1968; 6: 127–135.PubMedCrossRefGoogle Scholar
  94. 94.
    Chyong Y, Miura I, Ramez B, et al. Aortic root balloon pumping. Jpn Heart J 1971; 12: 263–274.PubMedCrossRefGoogle Scholar
  95. 95.
    Ganzel BL, Gray LA Jr, Masden RR, et al. New percutaneous intra-arterial cardiac support system. JACC 1991; 17: 279A.Google Scholar

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© Springer-Verlag New York Inc. 1995

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  • John Parker Gott

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