Physicians at the Medical College of Georgia and Georgia Regents University, Augusta, say that the intra-aortic balloon pump, one of the most frequently used mechanical circulatory assist devices in the world may have untapped potential. One of its many uses is helping ensure adequate oxygen and blood is delivered to a heart following coronary bypass surgery.
However, physicians have been advised not to use the balloon pump if heart surgery patients also have aortic insufficiency, when the aortic valve’s inability to close completely washes oxygen-rich blood back into the left ventricle. This can lead to making the heart chamber becoming enlarged and inefficient.
The medical team reports that using the balloon pump enabled them to wean a 63-year-old man with moderate aortic insufficiency off bypass when standard approaches failed. They said that using the intra-aortic balloon pump may be an option for patients with mild to moderate aortic insufficiency who don’t have severe atherosclerosis in their aorta, and whose left ventricular dysfunction is reversible.
Every textbook lists these pumps as contraindicated in these patients, but in this case, the patient continued to deteriorate despite maximal support. Sluggish hearts can occur following bypass surgery, where anesthesiologists essentially put the heart to sleep to dramatically decrease its metabolism and protect it during the procedure.
MCG Heart Surgeon Vijay Patel inserted the intra-aortic balloon pump through the femoral artery in the groin up into the aorta, the largest blood vessel in the body, to help strengthen the left ventricle. When inflated, the balloon can also increase leakiness around the aortic valve, which is why it’s not recommended with aortic insufficiency.
Almost immediately, the patient’s blood pressure and cardiac output increased and his heart started beating stronger. The physicians were able to take him back off bypass and to intensive care with the balloon still in place. They removed the balloon the next morning.
While considering the pump a reasonable last option for this very specific group of patients, they plan to do a small clinical trial to ensure that the findings continue to hold.