Intraaortic balloon counterpulsation.

The physiologic principle of hemodynamic circulatory support for the failing left ventricle must be directed toward reducing left ventricular work and myocardial oxygen demand and increasing myocardial oxygen supply. This support can best be accomplished with the use of intraaortic balloon counterpulsation. Support of the failing heart after cardiopulmonary bypass was the most frequent indication for counterpulsation treatment in our reported series. This type of assist was required in 5.2 percent of my patients. I reviewed the reports from three medical centers and added our own results in patients who required intraaortic balloon counterpulsation for weaning from cardiopulmonary bypass. Of a total of 399 patients, 255 or 73 percent were weaned off the balloon assist device and of this group, 239 or 60 percent were subsequently discharged from the hospital. Among patients who required intraaortic balloon counterpulsation for postoperative pump failure, 43 (70 percent) of 66 patients were weaned off the intraaortic balloon device, and 35 (53 percent) were later discharged from the hospital. A 24 percent survival rate occurred in patients with cardiogenic shock treated solely with counterpulsation; however, the survival rate increased to 52 percent when those patients subsequently received cardiac catheterization and appropriate surgical intervention.