Augusta, Ga. The most frequently used mechanical circulatory assist device in the world may have untapped potential, physicians say.
One of many uses for the intra-aortic balloon pump is helping ensure adequate oxygen and blood delivery to a heart struggling to resume beating in the aftermath of coronary bypass surgery, said Dr. Mary Arthur, cardiovascular anesthesiologist at the Medical College of Georgia and Georgia Regents Health System.
However physicians have been advised not to use the balloon pump if heart surgery patients also have aortic insufficiency. That's when the aortic valve's inability to close completely prompts oxygen-rich blood to backwash into the left ventricle. The heart chamber that pumps blood out to the body can get large and inefficient as a result.
Now, Arthur and her team report that the balloon pump enabled them to wean a 63-year-old man with moderate aortic insufficiency off bypass when standard approaches failed.
"This tells us that the intra-aortic balloon pump may be an option for patients with mild to moderate aortic insufficiency who don't have severe atherosclerosis in their aorta, and whose left ventricular dysfunction is reversible," Arthur said.
Dr. Tiffany Richburg, anesthesiology resident at MCG and the Georgia Regents Health System, presented the case Saturday during the Society of Cardiovascular Anesthesiologists' 36th Annual Meeting and Workshops in New Orleans.
"The pumps are listed in every textbook as contraindicated in these patients," Arthur said. "But we felt like we had no other option. The patient continued to deteriorate despite maximal support."
Said Richburg, "We had a difficult time weaning him off bypass: his blood pressure was extremely low, his cardiac output was extremely low, and his heart was not pumping well." The patient was immediately placed back on bypass.
Sluggish hearts can occur following bypass surgery, where an
|Contact: Toni Baker|
Medical College of Georgia at Georgia Regents University