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Ann Thorac Surg 1996;61:894
© 1996 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Hooshang Bolooki, MD

Division of Cardiothoracic Surgery University of Miami/Jackson Memorial Medical Center Miami, FL 33136

See also page 888.

Because of definite improvement in overall cardiac performance in the failing heart with intraaortic balloon pump assist there has been an overwhelming increase in the rate of use of this device. Little additional basic research has been done to seek answers to many questions regarding the mechanism of solutary effects of this device. This work by Kim and associates points to the fact that, despite 30 years of clinical experience, certain assumptions about the function of the intraaortic balloon pump are in need of clarification.

Kim and associates show that counterpulsation with an intraaortic balloon results in marked decrease in aortic impedance when ``assisted beats'' are compared with ``nonassisted beats.'' The method of analysis of efficacy of the intraaortic balloon pump with use of Doppler echocardiography to assess the instantaneous changes in pressure and flow (hence impedance) has been rarely used in the patients. With a decrease in impedance there is a proportionate increase in stroke volume and in left ventricular external power. Clinically these are represented by a decrease in peak systolic aortic pressure of the beat after ``the assisted beat'' and an increase in cardiac output. Unfortunately, this parameter was not studied in these patients.

The next step in research in this area should be an evaluation of the change in impedance in response to intraaortic balloon pumping at varying stages of cardiac dysfunction. Cardiac surgeons have been elemental in development and in research on the use of the intraaortic balloon pump. It is rewarding to see that they continue to do so. Clearly, intraoperatively and in the intensive care unit the surgeons are best qualified to study the efficacy of this device in altering the deranged physiology of cardiac failure with minimal adverse effects to the patient.


Related Article

Arterial Impedance in Patients During Intraaortic Balloon Counterpulsation
Shin Y. Kim, David E. Euler, William R. Jacobs, Alvaro Montoya, Henry J. Sullivan, Vassyl A. Lonchyna, and Roque Pifarré
Ann. Thorac. Surg. 1996 61: 888-894. [Abstract] [Full Text]




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