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Ann Thorac Surg 1976;22:535-545
© 1976 The Society of Thoracic Surgeons

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Articles

Evolving Indications for Preoperative Intraaortic Balloon Pump Assistance

From the Departments of Surgery and Medicine, University of Toronto Faculty of Medicine, and the Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ont, Canada

^* Address reprint requests to Dr. Goldman, Toronto General Hospital, 101 College St, Toronto, Ont, Canada M5G 1L7

Over a two-year period about 1,000 operations were performed with cardiopulmonary bypass. Intraaortic balloon pump assistance (IABP) was employed on 150 occasions, and a review of these has permitted clarification of the indications for its use.

Sixty patients had IABP for cardiogenic shock either after infarction or after cardiotomy, and 37 (62%) survived. Preoperative IABP in 90 high-risk patients resulted in survival for 79 (88%). The indications for prophylactic IABP included: (1) relief of severe pain, which occurred in 42 patients with acute coronary insufficiency, (2) improvement in the coronary perfusion pressure, which was accomplished in 20 patients with significant left main coronary artery occlusion or its equivalent, and (3) protection of left ventricular function, which was carried out in 28 patients with an LV ejection fraction of less than 0.40. The significance of the preoperative endocardial viability ratio (EVR) in relation to prophylactic IABP was also assessed: an EVR below 0.70 appears to be an indication for preoperative IABP.

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