The role of the intra-aortic balloon in cardiac anesthesia and surgery

The use of the intra-aortic balloon pump (IABP) in cardiac surgical patients has become accepted treatment. The purposes of this study were (1) to determine the frequency of use of the balloon, (2) to re-evaluate the indications for the IABP, and (3) to assess the hemodynamic effects of the balloon during surgery. In the past 24 months, the IABP was used in 63 of 1,738 (3.62%) adult cardiac surgical patients. Eight patients required the IABP prior to surgery due to complicated acute myocardial infarctions. In 13 patients, the IABP was used in the operating room before bypass for complicated infarctions or severe left ventricular dysfunction. It was not considered necessary before bypass in patients with left main coronary artery disease, moderately depressed left ventricular function, or unstable angina. In addition, 42 patients required the IABP to discontinue cardiopulmonary bypass. Detailed hemodynamic measurements were made in 11 patients. The IABP decreased systolic blood pressure, left and right ventricular filling pressures, and peripheral resistance, while it increased diastolic and mean arterial pressures, stroke work, cardiac output, and the endocardial viability ratio. The intra-aortic balloon was shown to be life-saving in certain patients. However, it should only be used selectively for specific indications. Careful surgical and anesthetic management with good monitoring can be used in many patients instead of the balloon.