Transaortic cannulation for balloon pumping in a "crowded aorta"

Transaortic intra-aortic balloon pump catheter insertion through a separate saphenous vein graft in patients with severe aortoiliac disease

Background. Intra-aortic balloon pump (IABP) is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases. Methods. This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum. Results. The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0 ± 13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft. Conclusions. This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.

Transthoracic intraaortic balloon pump: a simplified technique

A technique of transthoracic intraaortic balloon pump insertion and a clinical experience with 14 patients is reported. The technique of transthoracic intraaortic balloon pump insertion can be done in a rapid and atraumatic fashion. A short prosthetic graft is used, and intraaortic balloon pump removal does not require resternotomy. The technique is a safe alternative in postcardiotomy failure patients with inadequate peripheral arterial access.

Safe intraaortic balloon pump placement through the ascending aorta using transesophageal ultrasound

Intraaortic balloon pumping salvages a substantial number of patients who fail to be weaned from cardiopulmonary bypass after an open heart operation. Patients with severe peripheral vascular disease may require ascending aortic balloon pump insertion. We describe a simple method of direct aortic puncture for intraaortic balloon pump placement using transesophageal ultrasound as a means of avoiding complications during insertion and documenting correct balloon position.

Transthoracic intraaortic balloon pump support: experience in 39 patients

From June, 1982, through July, 1985, 39 (1.5%) of 2,570 patients undergoing open-heart procedures required insertion of a transthoracic intraaortic balloon pump (IABP). In all of these patients, a percutaneous attempt failed or was contraindicated. There were 24 (62%) men and 15 (38%) women. The mean age was 64.9 years. Five patients (13%) sustained complications potentially related to the transthoracic IABP. They included mediastinal infection in 1 patient (2.5%), balloon rupture in 2 patients (5%), and cerebrovascular accidents in 4 patients (10%). The overall survival was 44%. Survival for the group of patients weaned from transthoracic IABP support was 17 (81%) of 21. There were no deaths directly related to the transthoracic IABP. The transthoracic IABP was removed under local anesthesia without sternotomy in 19 (90%) of the patients weaned and with formal sternotomy in the remaining 2 (9%). In a select group of patients requiring intraaortic balloon counterpulsation, the use of the transthoracic IABP is a reasonable second choice for patients in whom other methods of balloon support are not feasible.

Direct ascending aortic insertion of the "percutaneous" intraaortic balloon catheter in the open chest: advantages and precautions

When intraoperative balloon pump support is needed for patients who cannot be weaned from cardiopulmonary bypass and when the balloon catheter will not pass retrograde into the aorta from the femoral artery, the catheter must be inserted into the ascending aorta directly. We have found that the new Datascope "percutaneous" balloon catheter offers many advantages for direct insertion into the ascending aorta, but certain precautions are necessary to prevent cerebral emboli when the percutaneous balloon catheter is used this way.