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Post-cardiotomy intra-aortic balloon counter pulsation: application and prognostic evaluation
D Agrawal1, S S Lohchab, N Mehta
1Department of Cardiothoracic Surgery, GB Pant Hospital, New Delhi.
Insights
Early intra-aortic balloon counter pulsation after cardiac surgery significantly reduces mortality. Promptly initiating this cardiac assistance, especially before cardiopulmonary bypass termination, is crucial for better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Critical Care Medicine
Background:
- Intra-aortic balloon counter pulsation (IABP) is a mechanical circulatory support device used in cardiac surgery.
- Patient outcomes can be influenced by the timing and method of IABP implementation.
- Minimizing complications associated with IABP insertion is essential for patient safety.
Purpose of the Study:
- To evaluate the impact of timing and insertion techniques of intra-aortic balloon counter pulsation on patient mortality and complications in cardiac surgical cases.
- To determine the optimal timing for initiating IABP to improve patient survival rates.
- To assess the efficacy of different IABP insertion methods, including percutaneous and open arteriotomy, and sheathless versus sheathed techniques.
Main Methods:
- A retrospective study of 113 cardiac surgical patients (91 male, 22 female) receiving intra-aortic balloon counter pulsation.
- Analysis of patient mortality based on the timing of IABP initiation relative to cardiopulmonary bypass (CPB) termination.
- Comparison of vascular and local complications between percutaneous and open arteriotomy insertion techniques, and sheathless versus sheathed insertion methods.
Main Results:
- Mortality was significantly lower (16%) when IABP was initiated before CPB termination compared to a 50% mortality with delays exceeding 15 minutes post-CPB.
- Early IABP assistance effectively reduced pulmonary capillary wedge pressure, with 1:2 augmentation proving more effective in patients with tachycardia.
- Percutaneous insertion (13.3%) and sheathless insertion (6.6%) resulted in fewer local complications than open arteriotomy (31.2%) and sheathed insertion (21.7%), respectively.
- Proper balloon placement prevented position-related complications and did not compromise left internal mammary artery blood flow.
Conclusions:
- The timing of intra-aortic balloon counter pulsation institution is critical for reducing mortality in cardiac surgery patients.
- Early initiation of IABP, ideally before cardiopulmonary bypass termination, significantly improves survival rates.
- Minimally invasive insertion techniques, such as percutaneous and sheathless methods, are associated with lower complication rates, enhancing patient safety.
Abstract:
Cardiac assistance by intra-aortic balloon counter pulsation was studied in 113 cardiac surgical cases comprising 91 male and 22 female patients. This included 82 percent of patients having coronary artery bypass surgery, while 18 percent were operated for valvular lesions. It was observed that the time of institution of cardiac assistance by intra-aortic balloon counter pulsation, following cardiac surgery, was of prime importance to decrease patient mortality. It was lowest (16%) when the balloon was inserted for assistance before termination and highest (50%) when there was delay of more than 15 minutes following termination of cardiopulmonary bypass. Early balloon assistance significantly lowered the pulmonary capillary wedge pressure and usually 1:2 augmentation was more effective, probably because of existing tachycardia in most patients. Advances in catheter technology have reduced the vascular complication at the insertion site. Percutaneous insertion had less local complications (13.3%) than open arteriotomy technique (31.2%). Similarly with sheathless insertion, complications were less (6.6%) in comparison to sheathed insertion (21.7%). Proper placement of balloon avoided position-related complications and there was no compromise of blood flow through left internal mammary artery as noticed in our series.