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Transascending aortic intraaortic balloon insertion with delayed sternal closure: A retrospective analysis
Clement C. Ugorji1, Stephen A. Turner, Michael G. McGee
1Cardiovascular Surgical Research Laboratories and the Division of Surgery, Texas Heart Institute of St. Luke's Episcopal and Texas Children's Hospitals, Houston, Texas.
Insights
Direct transaortic insertion of intraaortic balloon pumps (IABP) offers a viable alternative for patients with severe arterial occlusive disease. This method, combined with delayed sternal closure, effectively manages low cardiac output states post-cardiotomy.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Medical Device Technology
Background:
- Intraaortic balloon pumping (IABP) is crucial for managing low cardiac output after heart surgery or infarction.
- Standard IABP insertion via femoral or iliac arteries is often impossible in patients with severe arterial occlusive disease.
Purpose of the Study:
- To evaluate the efficacy and safety of a direct transaortic insertion method for IABP.
- To assess the utility of this approach in postcardiotomy patients with contraindications for peripheral arterial access.
Main Methods:
- A retrospective analysis of 28 adult postcardiotomy patients undergoing direct transaortic IABP insertion.
- Combined with delayed sternal closure to prevent cardiac tamponade.
- Utilized 30 and 40 ml balloons in 96% of patients.
Main Results:
- Successful IABP insertion was achieved in 96% of patients.
- No complications were directly attributed to the transaortic insertion site.
- Delayed sternal closure was safely performed within 48–96 hours.
- Overall survival rate was 28.6% due to patient comorbidities.
Conclusions:
- Direct transaortic IABP insertion is a safe and effective alternative when peripheral access is precluded by occlusive disease.
- This method allows for the use of larger, more effective IABP devices.
- Combining transaortic IABP with delayed sternal closure offers significant benefits in selected postcardiotomy patients.
Abstract:
Intraaortic balloon pumping (IABP) is an established therapeutic adjunct in the treatment of postcardiotomy/infarction low cardiac output states. Although the common femoral or iliac arteries are the preferred sites for balloon insertion, severe arterial occlusive disease may preclude entry by these methods. To circumvent this problem, alternative methods of insertion utilizing transthoracic approaches have evolved. In our institution, direct (transaortic) IABP insertion, combined with delayed sternal closure to avoid cardiac compression and possible tamponade, was performed in 28 adult postcardiotomy patients (mean age 60.4 +/- 3 years). The severity of generalized atherosclerosis was reflected in an overall survival rate of 28.6%. Retrospective analyses of the clinical courses of these patients revealed that the transaortic approach allowed utilization of larger and more effective balloons. Successful insertion of 30 and 40 ml balloons was accomplished in 27 of 28 (96%) of these patients, and one patient with a hypoplastic aorta required a 20 ml balloon. There were no complications directly attributable to this alternative site of balloon insertion, and tamponade was avoided. Delayed sternal closure was accomplished within 48 to 96 hours. We concluded that when severe peripheral vascular occlusive disease prevents insertion of intraaortic balloons via the femoral or iliac arteries in patients with low cardiac output, the alternative transaortic approach is indicated. Combined with delayed sternal closure in patients with postcardiotomy dilatation, additional benefits accrue.
