Intra-aortic balloon pumping in the management of patients with coronary artery disease

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At approximately the same time the first saphenous vein bypass grafts were being done in Cleveland, the clinical application of intra-aortic balloon pumping was initiated by Dr. Kantrowitz. The research efforts had been started by Moulopoulos and Kolff many years before. Rapidly following the first clinical application in 1967, other groups including the Massachusetts group initiated their efforts with the management of patients in cardiac failure with intra-aortic balloon assist. The early assumption was that the reduction of work during systole and the increase in diastolic pressure in the aortic root during diastole would greatly benefit patients with coronary artery disease. The premise for this benefit was that the marked increase in diastolic pressure would enhance coronary flow and in some circumstances increase the collateral flow to the ischemic areas related to myocardial failure.

Our early efforts focused on the application of intra-aortic balloon assist in patients who were in cardiogenic shock secondary to acute myocardial infarction. This was the same group of patients that Kantrowitz had selected for his early efforts with intra-aortic balloon. In the majority of patients the response was immediate. More than 75% showed marked hemodynamic improvement. Survival, however, in these patients depended upon many factors: (1) the duration of their cardiogenic shock secondary to the acute myocardial infarct; (2) the status of their cardiac compensation prior to their most recent infarct; and (3) a relative amount of ischemic muscle as opposed to necrotic muscle that was present at the time balloon assist was initiated in . . .



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