Balloon counterpulsation following surgery for ischemic heart disease

Intraaortic balloon counterpulsation (IABC) was used in 40 patients who developed left ventricular pump failure following surgery for ischemic heart disease. The IABC was inserted in the operating room in 32 patients, and within 36 hours of surgery in eight patients. Four patients could not be weaned from cardiopulmonary bypass and died in the operating room. Of the other 36 patients, eight died while on IABC. Twenty-eight patients (70%) were successfully weaned from IABC, although six died later in hospital. Twenty-two patients (55%) survived hospitalization. No late deaths have occurred at 5-33 months of follow-up (mean 16-4 months). Twenty (91%) of 22 survivors are Class I or II at time of this report. Postoperative pump failure occurs because of perioperative acute myocardial infarction and/or major preoperative left ventricular dysfunction. Patients with perioperative infarction who have no prior left ventricular dysfunction have a significantly lower mortality (14%) than do those patients with preoperative left ventricular dysfunction who have subsequent acute perioperative infarction (mortality 67%) P less than 0.05.