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Intra-Aortic Balloon Pump (IABP)

The intra-aortic balloon pump (IABP) is a mechanical device that improves the function of the left ventricle, which helps the heart pump blood. It is a long, thin tube (catheter) with a balloon on the end of it that is inserted into the aorta, the body’s largest artery. The balloon inflates and deflates with the rhythm of your heart.

The left ventricle is the chamber that pumps blood into your aorta. An intra-aortic balloon pump inflates when your left ventricle has finished contracting. This helps increase blood flow to the rest of the body. As the left ventricle is about to pump out blood, the balloon deflates, creating extra space in the aorta for more blood to be pumped out. This decreases the workload on the heart.

Indications
  1. Acute mitral valve regurgitation.
  2. Severe heart failure.
  3. Failure to wean from cardiopulmonary bypass.
  4. Cardiogenic shock.
  5. Acute heart attack.
  6. Support during high-risk percutaneous transluminal coronary angioplasty, rotablator procedures, and coronary stent placement.
  7. Support for high-risk patients during other types of surgery, as determined necessary by the doctor.
  1. Severe aortic valve regurgitation.
  2. Dissecting aortic aneurysm.
  3. Aortoiliac occlusive disease.
  4. Blood clotting abnormalities.
  5. Brain death.
  6. End-stage cancer.
  7. Heart disease that cannot be treated with a heart transplant.
The intra-aortic balloon pump may be indicated for the following patients with appropriate preparation:
  1. Patient with coronary artery graft.
  2. Patient with coronary artery aneurysm.
  3. Patient with aortofemoral graft.
  1. An officer will prepare the required equipment, which includes a 25-50 milliliters catheter with a balloon at one end and a pump to control the balloon that is filled with helium gas.
  2. Before placing the catheter, the doctor will choose one of the appropriate size based on the patient’s height.
  • Height less than 152 centimeters – 25 milliliters
  • 152-162 centimeters – 34 milliliters
  • 162-183 centimeters – 40 milliliters
  • Height more than 183 centimeters – 50 milliliters
  • Small balloons are best for children. The balloon capacity should be no more than 80-90% of the chest circumference where the descending thoracic aorta is.
  1. The doctor will select a location to insert the catheter by choosing from several arteries, such as the subclavian artery, the axillary artery, or the femoral artery. The femoral artery is most often used.
  2. The doctor will ask you about your medical history, past medication use, and any history of allergies. Some medications you are taking may need to be stopped before the procedure, such as blood-thinning medication.
  1. Before inserting the catheter the doctor will clean the insertion site and then administer a local anesthetic.
  2. The doctor will insert the catheter into an artery (the femoral artery is pictured here) and thread it into the left side of the heart and the subclavian artery. The other end of the catheter will be in the artery close to the kidney. An imaging study of the lung would show the tip of the catheter between the second and third rib. The length of the catheter will depend on the height of the patient to prevent blockage of the blood vessels at both places.
  3. The balloon will set to compress and expand according to the rhythm of the heart and these contractions will move blood from the heart. Helium gas is used to control the pressure of the balloon and it will function when the heart relaxes.
  1. The nurse will assess the function of your heart by monitoring your vital signs, carrying out an electrocardiogram (EKG), and evaluating your urine every hour. If any abnormalities are found, your doctor will be notified immediately to treat the problem.
  2. The nurse will teach you how to detect any complications, such as bruising of your hands and feet, infection, and blood clots.
  3. The nurse/doctor will assess and monitor the function and settings of the machine by noticing the values displayed on the balloon pump console and follow-up x-rays to ensure proper position.
  4. You will be advised not to bend the leg where the catheter is inserted. If you are unable to cooperate, your leg may be tied in place or the doctor may administer sedatives to keep you calm.
  5. The intra-aortic balloon pump will only temporarily support the function of your heart. The machine will slowly be withdrawn when your heart’s function improves, as evaluated by your medical team.
  1. Transient loss of peripheral pulse
  2. Limb ischemia
  3. Blocked blood vessels
  4. Damage to the aorta
  5. Injury to the blood vessels
  6. Infection
  7. Damage to the balloon
  8. Low platelets or damage to red blood cells
  9. Impact on other organs (such as brain, kidney) due to cardiac tamponade
Before the Procedure
  • You should plan to stay in Thailand for at least two weeks through the duration of your treatment.
  • It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.
After the Procedure
  • At your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation regarding your surgery or procedure and all other relevant documentation for traveling.
  • Avoid activities that require strenuous pulling, pushing, shoving, or lifting as well as kneeling. These can cause bleeding from the injection site at the groin.
  • Keep the injection site at the wrist or groin dry and clean until it is fully healed. Please let the doctor know if you experience redness, swelling, and/or severe pain. If the bleeding does not stop, please place pressure on the site and talk to your doctor immediately.
  • When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis.
  • Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
 
What if the procedure is not performed?
Please discuss specific risks of not having the procedure done with your doctor.
The doctor may consider the use of a left ventricular assist device (LVAD) which takes the place of the left ventricle. Surgery is performed to place an inflow cannula to receive blood from the left atrium, which then travels through the pump and into the outflow cannula and to the ascending aorta and the rest of the body.

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