Ann Thorac Surg 2002;74:1090-1091
© 2002 The Society of Thoracic Surgeons
Invited commentary
David F. Torchiana, MDa
a Massachusetts General Hospital, Division of Cardiac Surgery, Bull Finch 119, 55 Fruit Street, Boston, MA 02114, USA
e-mail: dtorchiana{at}partners.org
In the current era of ventricular assistance and artificial hearts, the treatment of patients with end-stage heart failure is evolving. The venerable intraaortic balloon pump (IABP), in its fourth decade of use, remains the mainstay of therapy in patients with acute coronary syndromes or post cardiotomy heart failure. This multicenter paper uses a data registry to review contemporary complication rates of intraaortic balloon pump therapy. The study is flawed by the voluntary nature of the registry and may not be representative of the entire spectrum of clinical practice, but nonetheless has the following features of interest:
- Preoperative balloon placement in the catheterization laboratory is associated with fewer complications and possibly with better cardiac outcomes. There are several good reasons for this. Insertion is technically easier with fluoroscopic guidance, and the institution of balloon pumping before surgery, as opposed to after a problem develops, is probably beneficial in a high risk subset of patients.
- Significant vascular complications of intraaortic balloon pumping have become relatively rare, with limb loss or death due to the IABP almost nonexistent. As with most medical advances, one presumes this relates to patient selection, operator expertise, and technological improvements with modern catheters that are smaller and more flexible in design.
Intraaortic balloon pump use, particularly preoperative insertion, appears to be increasing at many centers. The basic physiology of counterpulsation, reducing afterload in systole and augmenting coronary perfusion in diastole, remains a masterfully conceived intervention. As described in this report, the IABP continues to serve physicians and patients with heart disease well.
