Introduction: Intra-aortic Balloon Pumping as an Established Clinical Method

Abstract

By definition, counterpulsation is a method for assisting the heart in series on the basis of the ECG (Fig. 1). The goal is to unload the left ventricle in the ejection phase and to increase the myocardial blood supply in the filling phase of the heart. Due to the fact that counterpulsation works in series for the natural heart, the devices are up to 25% effective and depend on a certain amount of residual minimal circulation. In cases of complete heart deteration or fibrillation, the systems do not work and more capable devices are necessary. Intra-aortic balloon pumping is, at the present time, indicated for:

• 1. Pump failure after open heart surgery

• 2. Cardiogenic shock after myocardial infarction

• 3. Cardiogenic shock in acute heart failure

• 4. Chronic support for cardiomyopathies

In cases with postoperative heart failure the first step in the cascade of assisted circulation is intra-aortic balloon pumping. This method was reported by Moulopoulos and Kolff in 1962 and Kantrowitz in 1967, and since then has become very well established in clinical use. The basic principle of this technique is to assist the failing heart in series according to the ECG. A balloon built of polyurethane is implanted in the descending aorta via the femoral artery. The balloon is pneumatically driven according to the ECG.