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Ann Thorac Surg 1998;66:603
© 1998 The Society of Thoracic Surgeons

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Correspondence

Ascending versus descending balloon counterpulsation

^a Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA 02118, USA

To the Editor

I read with interest the article by Gitter and coworkers on the "Influence of Ascending Versus Descending Balloon Counterpulsation on Bypass Graft Blood Flow" [1]. My colleagues and I became interested in the concept of placing the intraaortic balloon pump (IABP) in the ascending aorta as a result of several patients who required an ascending aortic insertion of an IABP because of absent femoral pulses or aortoiliac disease. Positioning the IABP into the descending aorta from the ascending aorta may be difficult and hazardous. Manipulation of the transverse arch and proximal thoracic aorta may dislodge mural thrombi, resulting in arterial emboli. It seemed to be technically easier to leave the IABP in the ascending aorta. We therefore undertook an experimental study to determine the effects of positioning the IABP in the ascending aorta on myocardial recovery during urgent surgical revascularization [2]. In adult pigs, the second and third coronary arteries were occluded with snares for 90 minutes followed by 30 minutes of cardioplegic arrest and 180 minutes of reperfusion with the snares released. During the period of coronary occlusion, 10 pigs received an IABP in the descending aorta, whereas 10 others had a spherical IABP placed in the ascending aorta just above the aortic valve. The best recovery of wall motion, least tissue acidosis, and lowest area of necrosis occurred when the IABP was positioned in the ascending aorta.

We agree with Dr Bolooki’s comments in the discussion that the best role of an ascending aortic IABP would be for those patients in whom there is difficulty discontinuing cardiopulmonary bypass after a descending aortic IABP is unsuccessful. Nonsurgical patients in cardiogenic shock may also benefit from the improved hemodynamics of an ascending aortic IABP.

References

1. Gitter R., Cata C.M., Smart K., Jett G.K. Influence of ascending versus descending balloon counterpulsations on bypass graft blood flow. Ann Thorac Surg 1998;65:365-370.[Abstract/Free Full Text]
2. Lazar H.L., Matsuura H., Rivers S., Shemin R.J. Reduction of myocardial necrosis by positioning the intra-aortic balloon pump in the ascending aorta. Cardiovasc Surg 1994;2:634-637.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harold L. Lazar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazar, H. L. Search for Related Content PubMed Articles by Lazar, H. L.