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Thorac Cardiovasc Surg 2003; 51(3): 115-125
DOI: 10.1055/s-2003-40315
Editorial
© Georg Thieme Verlag Stuttgart · New York

Peri-operative Intraaortic Balloon Assist, Decreasing Complications to the Minimum

F.  Robicsek1 , J.  H.  Holleman1 , T.  S.  Roush1 , E.  R.  Skipper1 , S.  A.  Robicsek1 , M.  Lyons1
  • 1Department of Thoracic and Cardiovascular Surgery, Carolinas Heart Institute and the James H. Heineman Vascular Center, Carolinas Medical Center, Charlotte, North Carolina
Further Information

Publication History

Received: March 31, 2003

Publication Date:
30 June 2003 (online)

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IABP can be a life-saving procedure, but it carries a significant morbidity and mortality. This makes it imperative to temper our indication JM Alvarez, 1992 [1].

The difference in complications rate is due to physicians' experience and technique MJ Goldberg, 1987 [2].

Intra-aortic balloon assist (IABA) has two main beneficial effects. First, it augments coronary flow through diastolic balloon inflation; second, it reduces after-load through rapid balloon deflation in systole. IABA was first used clinically in 1968 to support the failing circulation of patients after myocardial infarction [3]. Its use was soon extended to patients in need of perioperative support in cardiac surgery [4]. Because there are no physiological shortcomings of IABA, indications for its use is established result from weighing up probable benefits vs. possible harm. Given the fact that any mechanical mishaps with IABA devices of recent manufacture are rare, the expression “possible harm” refers to vascular problems, for all intents and purposes, to limb ischemia, and less frequently to hemorrhage [5]. These two represent about 90 % [6] [7] of all IABA-related complications [6].

In his review paper, Alvarez stated that “The desperate condition of these patients (i. e., who require LABP) forces us begrudgingly to accept the associated morbidity and mortality” [1]. We disagree with this view, and emphasize that such a “desperate condition” may never develop with judicious indication; and even if it does occur, significant vascular complications may be prevented.

It is also reasonable to postulate that if the rate of vascular mishaps could be significantly decreased, the application of perioperative IABA may be considerably liberalized. The purpose of this paper is to present our recommendations based on thirty years experience [8] [9] [10] [11] [12] as to how the current number of complications of IABA may be decreased to the very minimum.

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F. Robicsek, MD 

Medical Center, the Carolinas Heart Institute, Dept. of Cardiovascular and Thoracic Surgery

P.O. Box 32861

Charlotte NC 28232

USA