[Use of intra-aortic balloon in cardiac surgery]

Use of the intra-aortic balloon in the treatment of circulatory failure after cardiac surgery has resulted in the long-term survival of 7 patients out of 20. The failures occured when the myocardium is severely compromised so that any treatment is likely to fait (8/13), and where there is the ultimate complication of renal or hepatic failure (4/13), irreversible ventricular failure or secondary haemorrhage. In urgent coronary bypass surgery (4/13) it would appear that the use of the balloon preoperatively would have avoided or at least slowed the progress toward the anatomical changes of massive infarction. As the use of the balloon has often been associated with a reduction in the number of circulating platelets and a pathological increase in the breakdow products of fibrin, heparin is now used systematically in an attempt to prevent the development of a true intravascular coagulation syndrome. The use of lidocaine is also recommended to prevent fatal or dangerous ventricular arrhythmias when the balloon is functioning well. A combination of the intra-aortic balloon with the infusion of small doses of adrenaline would seem to be an interesting therapeutic combination, especially at the onset of counterpressure.