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Updated: Jun 10, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Intraoperative intra-aortic balloon pump insertion: step by step
Carla Gotsens-Asenjo1, Constanza Fernández-De Vinzenzi1, Elena Roselló-Díez1
1Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau - Sant Pau Biomedical Research Institute (IIB SANT PAU), Barcelona, Spain.
Insights
This study highlights the successful use of an intra-aortic balloon pump (IABP) to stabilize a patient with severe left ventricular dysfunction during urgent off-pump coronary artery bypass grafting surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Medical Devices
Background:
- A 76-year-old patient presented with non-ST elevation myocardial infarction and severe left ventricular dysfunction.
- Coronary angiography revealed significant left main and two-vessel coronary artery disease, necessitating urgent surgical intervention.
Observation:
- An intra-aortic balloon pump (IABP) was inserted pre-operatively under echocardiographic guidance to ensure hemodynamic stability.
- The IABP catheter was positioned in the descending thoracic aorta, confirmed by transesophageal echocardiography.
- The patient underwent double off-pump coronary artery bypass grafting via median sternotomy.
Findings:
- The intra-aortic balloon pump effectively maintained hemodynamic stability throughout the complex surgical procedure.
- The patient was extubated shortly after surgery, and the IABP was removed on postoperative day two without complications.
Implications:
- Intra-aortic balloon pump support is a valuable strategy for managing patients with compromised left ventricular function undergoing off-pump coronary artery bypass grafting.
- This case demonstrates the feasibility and safety of IABP use in high-risk cardiac surgery patients.
- Optimized hemodynamic management, including IABP use, can lead to favorable outcomes in complex coronary artery disease cases.
Abstract:
A 76-year-old patient with non-ST elevation myocardial infarction was admitted to our hospital. Coronary angiography revealed significant left main and two-vessel coronary artery disease. Preoperative testing indicated severe left ventricular dysfunction. The patient was scheduled for urgent off-pump coronary artery bypass grafting. Due to the low ejection fraction, an intra-aortic balloon pump was inserted in the operating theatre before sternotomy, to enhance the patient's haemodynamic stability during surgery. A 6 Fr introducer was inserted into the femoral artery under echocardiographic guidance. Using a 150-cm guidewire, the intra-aortic balloon catheter was advanced through the introducer to the descending thoracic aorta. The catheter's tip position, just distal to the origin of the left subclavian artery, was confirmed via transoesophageal echocardiography. The external part of the catheter was secured to the skin and connected to the balloon console. Therapy was initiated, and the inflation/deflation parameters were optimized. A double off-pump coronary artery bypass was performed via median sternotomy. The patient remained haemodynamically stable throughout the surgery, aided by the intra-aortic balloon pump, and careful volume and vasoactive management. The patient was extubated promptly, and the device was removed on the second postoperative day without complications.
