Ann Thorac Surg 2002;73:891
© 2002 The Society of Thoracic Surgeons
Original article: cardiovascular
Invited commentary
Ralph E. Delius, MDa
a Division of Cardiovascular Surgery, Children’s Hospital of Michigan, 3901 Beaubien Blvd Detroit, MI 48201-2196 USA
e-mail: rdeliu{at}dmc.org
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It is perhaps a cliché, but the notion that necessity is the mother of invention is clearly demonstrated in the report by Pinkney and associates regarding the use of the intraortic balloon pump (IABP) in children. Extracorporeal membrane oxygenation (ECMO) is the most prevalent means of mechanical circulatory assistance in the pediatric population. However, the authors are at an institution that has elected to not have an ECMO program. It is widely accepted that some form of mechanical support is needed for any serious congenital heart surgery program. Consequently, the Primary Children’s Hospital group have become expert at providing mechanical support by an alternative means. Although the use of the IABP is universal in adult cardiac surgical circles, the use of this device has not caught on in pediatric heart centers for reasons nicely elucidated in the article. Although skepticism remains, the group at Primary Children’s Hospital has unequivocally demonstrated that IABP support can be used successfully in children. However, to be successful there must be fastidious attention to detail (cannulation, timing, etc) and the technique is more effort and time consuming than in adult patients. It is also clear, however, that IABP is not as universally useful as ECMO, as the technique appears to be less useful for RV function and not useful at all for patients with severe pulmonary hypertension. Consequently, it is unclear how IABP fits into the spectrum of mechanical support for pediatric patients. ECMO and ventricular assist devices have greater flexibility and consequently have more adherents, but IABP may be useful for groups that do not have access to this technology.
Related Article
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Current results with intraaortic balloon pumping in infants and children
- Kerrie A. Pinkney, L. LuAnn Minich, Lloyd Y. Tani, Gregory B. Di Russo, L. George Veasy, Edwin C. McGough, and John A. Hawkins
Ann. Thorac. Surg. 2002 73: 887-891.
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