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Mechanical support of the circulation

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Abstract

The recent development of modern direct techniques for coronary revascularization has made open heart surgery available to many critically ill patients. In an effort to deal with the increasing numbers of patients who require urgent open heart surgery and who have either many complicated patterns of coronary artery disease or valvular heart disease, or both, a spectrum of cardiac assist measures ranging from simple pharmacologic maneuvers to a variety of mechanical cardiac assist techniques have been developed. Temporary mechanical cardiac assist devices that use the principle of arterial counterpulsation have met with the most consistent clinical success.1 It is the purpose of this paper to summarize our clinical experience with intraaortic balloon pumping (IABP) and the pulsatile assist device in patients requiring open heart surgery at the Columbia-Presbyterian Medical Center.

Intraaortic balloon pumping

IABP is the temporary mechanical cardiac assist technique of choice for the management of refractory intraoperative left ventricular power failure.2, 3 Before the institution and use of IABP, left ventricular power failure and refractory ventricular tachyarrhythmias had been associated with a mortality of more than 90%.1

Our experience with IABP has been in conjunction with the System 80 and more recently System 82 (Datascope Corporation, Paramus, New Jersey) and the dual-chambered intraaortic balloon, both of which have been described.1–4 The balloon is passed through the common femoral artery with the stronger pulse and is positioned just distal to the left subclavian artery. The balloon is passed through a 10-mm woven Dacron side arm graft, which is . . .


 

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