Balloon Pump: May Be Option for Patients with Mild to Moderate Aortic Insufficiency

Mary E. Arthur, MD Cardiothoracic and ICU Anesthesia Department of Anesthesiology and Perioperative Medicine Georgia Regents University, Augusta, GAMedicalResearch.com interview with:
Mary E. Arthur, MD
Cardiothoracic and ICU Anesthesia
Department of Anesthesiology and Perioperative Medicine
Georgia Regents University, Augusta, GA

 

MedicalResearch.com: What made this cardiac case challenging?

Dr. Arthur: The left ventricle of our patient’s heart was functioning very poorly, and he required maximum pharmacologic support after he was weaned from cardiopulmonary bypass at the end of a 4-vessel coronary artery bypass graft procedure. His blood pressure and cardiac output were extremely low and his heart was not pumping well and so we put him back on bypass. Under routine circumstances, using an intra-aortic balloon pump is the next logical step, however it was inadvisable in this patient because he had moderate aortic insufficiency (a leaky aortic valve).

MedicalResearch.com: Why did you decide to use the balloon pump if it is not recommended for patients with aortic insufficiency?

Dr. Arthur: After discussions with the surgeons, we decided to proceed with the balloon pump. We wanted to avoid more aggressive but riskier interventions such as extracorporeal membrane oxygenation (ECMO) or uni- or bi-ventricular cardiac assist devices.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Arthur: Yes. We expected the severity of the aortic insufficiency to worsen after we placed the balloon pump, but it stayed the same while left ventricular function improved.

MedicalResearch.com: What are the main findings from this case?

Dr. Arthur: Although the patient had aortic insufficiency, the balloon pump led to a significant improvement in the left ventricle. This allowed us to de-escalate pharmacologic support, improve end-organ perfusion, and wean the patient off cardiopulmonary bypass.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Arthur: Our case suggests that balloon pumps may be an option for patients with mild to moderate aortic insufficiency if they do not have severe atherosclerosis in the aorta and if their left ventricular dysfunction is reversible.

MedicalResearch.com: What recommendations do you have for future research as a result of this report?

Dr. Arthur: We first plan to examine a database to determine how this intervention has been used in patients with this degree of aortic insufficiency and what their outcomes were across the nation. We hope to tease out which group of patients would benefit from this potentially lifesaving measure and could avoid riskier and more complicated surgical interventions. After  the retrospective analysis, I believe a randomized clinical trial using very specific selection criteria would guide treatments for this group of patients.

Citations:

Rius JB, Mercè AS, del Blanco BG, Aguasca GM, Mas PT, García-Dorado García D.
Resolution of shock-induced aortic regurgitation with an intraaortic balloon pump.
Circulation. 2011;124(4):e131.

Dr. Arthur’s abstract presented at the March 2014 ACC Meeting

Resolution of shock-induced aortic regurgitation with an intraaortic balloon pump

 

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