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Intra-aortic balloon pump

Principles of action

  • Myocardial ischemia can cause a fall in cardiac output
  • Coronary blood flow may subsequently be reduced
  • Compensatory mechanisms may further reduce cardiac output
  • Cardiac performance can be improved by optimisation of
    • Preload
    • Afterload
    • Heart rate
    • Contractility
    • Myocardial oxygenation
  • Balloon pump provides haemodynamic support to the failing heart
  • It reduces risk of cardiac ischaemia
  • The intra-aortic balloon pump works by
    • Increasing blood flow in the coronary arteries
    • Reducing the work of the cardiac muscle
  • Balloon is inflated in diastole
    • Increases diastolic coronary artery perfusion pressure
    • Increases myocardial oxygen supply
  • Balloon is deflated in systole
    • Reduces impedance to left ventricular ejection
    • Reduces myocardial oxygen demand

Indications

  • Perioperative myocardial ischaemia
  • Acute mitral valve regurgitation
  • Postoperative low cardiac output states
  • Preoperative use in high-risk coronary artery surgery
  • Refractory left ventricular failure
  • Cardiogenic shock
  • Impending myocardial infarction

Contraindications

  • Severe aortic regurgitation
  • Severe calcific aorto-iliac disease
  • Severe peripheral vascular disease
  • Aortic dissection

Mechanics of the pump

  • Catheter is inserted through the femoral artery using a Seldinger technique
  • Tip of the balloon is placed about 2cm distal to left subclavian artery
  • Balloon pump timing is triggered from the ECG or arterial wave form
  • Inflation occurs at the peak of the T wave at the end of systole
  • Deflation occurs just before the R wave
  • Correct timing of inflation and deflation is essential for optimum diastolic augmentation
  • Factors that reduce stroke volume lower diastolic augmentation

Complications

  • Limb ischaemia
  • Bleeding at insertion site
  • Thromboembolism
  • Balloon leak
  • Thrombocytopenia
  • Infection
  • Aortic dissection

Bibliography

Baskett R J,  Ghali W A,  Maitland A et al.  The intra-aortic balloon pump in cardiac surgery.  Ann Thorac Surg 2002;  74:  1276-1287.

Sanbom T A,  Feldman T.  Management strategies for cardiogenic shock.  Curr Opin Cardiol 2004;  19:  608-612.

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