Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to...Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.展开更多
Axillary intra-aortic balloon pump(IABP)used has increased in the recent few years after UNOs allocation system changes.IABP’s design and counterpulsation mechanism is highly regarded for its safety profile,simplicit...Axillary intra-aortic balloon pump(IABP)used has increased in the recent few years after UNOs allocation system changes.IABP’s design and counterpulsation mechanism is highly regarded for its safety profile,simplicity and relative ease in management and care.However,despite continuous innovative efforts,the potential for complications still exists.The Benchmark registry is widely regarded as the tool for monitoring the evolving practice of IABP.The most common complications reported are balloon perforation,bleeding,migration,limb ischemia.Despite continuous innovative efforts,the potential for complications still exists.展开更多
The effects of intra-aortic balloon pumping(IABP) on hemodynamic parameters inthe kidney were studied. The pulse produced by pumping activated the renal nervoussystem and reduced the renal vascular resistance. Therefo...The effects of intra-aortic balloon pumping(IABP) on hemodynamic parameters inthe kidney were studied. The pulse produced by pumping activated the renal nervoussystem and reduced the renal vascular resistance. Therefore, the reduction of the renalvascular resistance is an important reason for the increase the renal blood flow duringintra-aortic balloon pumping.展开更多
Intra-aortic balloon pump (IABP)support is used in severalclinical situations.To determine its efficacy in patients with severe heartfailure awaiting cardiac transplantation,the experience at the Universityof Pittsbur...Intra-aortic balloon pump (IABP)support is used in severalclinical situations.To determine its efficacy in patients with severe heartfailure awaiting cardiac transplantation,the experience at the Universityof Pittsburgh from May 1986 to October 1989 was reviewed.Of 392 patientson the waiting list,(16.3%) required IABP.All had previously been oninotropic support for varying periods of time.The ability to stabilize andto sustain the patient to cardiac transplantation was 75%.Twenty patients(31.3% of group) required and were provided more extensive mechanicalzsupport with either total artificial heart (n=ll) or left ventrieular assistdevice (n =9).Twenty-nine patients (45% of entire gronp) were able tohave the IABP removed prior to transplantation.Seventeen patients(26.6%)parameters demonstrated improvement with IABP.These data support IABPas a bridge to transplantation in patients with severe heart failure who havenot been stabilized on inotropie agents alone.These data also demonstratethat IABP support may only be required temporarily in a subgroup of pa-tients awaiting cardiac transplantation.展开更多
文摘Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.
文摘Axillary intra-aortic balloon pump(IABP)used has increased in the recent few years after UNOs allocation system changes.IABP’s design and counterpulsation mechanism is highly regarded for its safety profile,simplicity and relative ease in management and care.However,despite continuous innovative efforts,the potential for complications still exists.The Benchmark registry is widely regarded as the tool for monitoring the evolving practice of IABP.The most common complications reported are balloon perforation,bleeding,migration,limb ischemia.Despite continuous innovative efforts,the potential for complications still exists.
文摘The effects of intra-aortic balloon pumping(IABP) on hemodynamic parameters inthe kidney were studied. The pulse produced by pumping activated the renal nervoussystem and reduced the renal vascular resistance. Therefore, the reduction of the renalvascular resistance is an important reason for the increase the renal blood flow duringintra-aortic balloon pumping.
文摘Intra-aortic balloon pump (IABP)support is used in severalclinical situations.To determine its efficacy in patients with severe heartfailure awaiting cardiac transplantation,the experience at the Universityof Pittsburgh from May 1986 to October 1989 was reviewed.Of 392 patientson the waiting list,(16.3%) required IABP.All had previously been oninotropic support for varying periods of time.The ability to stabilize andto sustain the patient to cardiac transplantation was 75%.Twenty patients(31.3% of group) required and were provided more extensive mechanicalzsupport with either total artificial heart (n=ll) or left ventrieular assistdevice (n =9).Twenty-nine patients (45% of entire gronp) were able tohave the IABP removed prior to transplantation.Seventeen patients(26.6%)parameters demonstrated improvement with IABP.These data support IABPas a bridge to transplantation in patients with severe heart failure who havenot been stabilized on inotropie agents alone.These data also demonstratethat IABP support may only be required temporarily in a subgroup of pa-tients awaiting cardiac transplantation.
