Intra-aortic balloon pump

Economic Aspects. The cardiovascular devices market is estimated to be approximately 2.9 biUion annually on a worldwide basis. This market can be further segmented as follows angiography and angioplasty, 644 x 10 arrhythmia control, 1500 x 10 cardiovascular surgery, 700 x 10 cardiac assist (intra-aortic balloon pump), 80 x 10 and artificial hearts, which are experimental. 

Other efforts have led to the development of ventricular assist devices to support the heart for several months and intra-aortic balloon pumps (lABPs) which are widely used to unload and stabilize the heart. 

Ca.rdia.c-AssistDevices. The principal cardiac-assist device, the intra-aortic balloon pump (lABP), is used primarily to support patients before or after open-heart surgery, or patients who go into cardiogenic shock. As of the mid-1990s, the lABP was being used more often to stabilize heart attack victims, especially in community hospitals which do not provide open-heart surgery. The procedure consists of a balloon catheter inserted into the aorta which expands and contracts to assist blood flow into the circulatory system and to reduce the heart s workload by about 20%. The disposable balloon is powered by an external pump console. 

Hypovolemia, intraprocedural volume depletion, use of large volumes of contrast, and intra-aortic balloon pump... 

Siloxane-containing devices have also been used as contact lenses, tracheostomy vents, tracheal stents, antireflux cuffs, extracorporeal dialysis, ureteral stents, tibial cups, synovial fluids, toe joints, testes penile prosthesis, gluteal pads, hip implants, pacemakers, intra-aortic balloon pumps, heart valves, eustachian tubes, wrist joints, ear frames, finger joints, and in the construction of brain membranes. Almost all the siloxane polymers are based on various polydimethylsiloxanes. 

There are several other commercial products containing segmented polyurethane (SPU) such as pellethane or cardiothane. These SPUs are widely recognized to possess notable biomedical properties as materials for artificial heart and intra-aortic balloon pumping (IABP), and also as coating materials for pacemaker-lead insulators (See Sect. 4.1). 

Preventing CIN is of particular importance in patients with diabetes and chronic kidney disease, as these are two of the most powerful independent risk factors for CIN (77), Diabetics are more susceptible to (CIN) than are the nondiabetics, and diabetics with pre-existing chronic kidney disease (CKD) are at even greater risk (78). In a recently proposed CIN risk-scoring system, patient characteristics such as diabetes, age >75, chronic congestive heart failure, admission with acute pulmonary edema, hypotension, anemia and chronic kidney disease and various procedure-related characteristics including increasing volumes of contrast media, and intra-aortic balloon pump use were all found to reliably contribute to increased risk (79). 

Diabetes is a major risk factor for deterioration in renal function after angiography (2,7,13). Other factors variably associated with increased rates of CIN include age over 75 years, anemia, female gender, periprocedural volume depletion, heart failure, cirrhosis, hypertension, proteinuria, concomitant use of nonsteroidal anti-inflammatory drugs, and intra-arteriai injection (2,4,5,7,10,13,14,19,43,44). In the setting of acute myocardial infarction or PCI, hypotension or use of an intra-aortic balloon pump has been associated with a higher rate of acute renal failure after exposure to a contrast medium (13,50). Finally, high doses of CM also increase the likelihood of renal dysfunction (51). 

Anemia baseline hematocrit value <39% for men and >36% for women congestive heart failure class III/1V by New York Heart Association classification and/or history of pulmonary edema Hypotension systolic blood pressure <80mmHg for at least 1 hr requiring inotropic support with medications or intra-aortic balloon pump (IABP) within ... 

The use of techniques of circulatory support (extracorporeal oxygenation and intra-aortic balloon pump) in seven cases of overdose with antidysrhythmic drugs (disopyramide, flecainide, prajmaline, and quinidine) has been reviewed (62). 

A 32-year-old man became deeply comatose, with intraventricular conduction disturbances, after taking dextropropoxyphene 4.6 g. Treatment-resistant seizures lasted for hours. He was treated with an intra-aortic balloon pump and a continuous infusion of milrinone for 7 days and recovered fully. 

Gillard P, Laurent M. Dextropropoxyphene-induced cardiogenic shock treatment with intra-aortic balloon pump and milrinone. Intensive Care Med I999 25(3) 335. 

I IA IAA IABC IABP LAC IAC-CPR independent impression incisal one intra-amniotic interrupted aortic arch intra-aortic balloon counterpulsation intra-aortic balloon pump internal auditory canal interposed abdominal compressions-cardiopulmonary resuscitation... 

Artificial circulatory support can be broadly classified into two categories. The first category is for those patients who undergo open heart surgery to correct valvular disorders, ventricular aneurysm, or coronary artery disease. In several cases, the heart may not recover sufficiently after surgery to take over the pumping action. In such patients ventricular assist devices are used as extracorporeal devices to maintain circulation until the heart recovers. Other ventricular assist devices include intra-aortic balloon pumps as well as... 

Equipment standardization, while being at times difficult and costly to achieve, can be very helpful in minimizing use errors—especially in times of stress. At the very least, every effort should be made to standardize the life support devices, for example, defibrillators, ventilators, intra-aortic balloon pumps, and electrosurgical units. 

Fig. 7. Intra-aortic balloon pumps, requiring mechanical and fatigue strength along with physiological inertness, are fabricated from silicone-urethane IPNs (courtesy Kontron Cardiovascular).

The most commonly used means of mechanical circulatory support is the intra-aortic balloon pump (lABP). In 1990, it was estimated that lABP therapy was provided to 70,000 patients aimually (Kantrowitz, 1990). As described below, the lABP can provide only limited cardiovascular support, as its effects are limited to pressure unloading of the ventricle, in contrast to artificial hearts and ventricular assist devices, which provide volume unloading (Mehlhom et al., 1999). To be effective, the lABP requires that the patient maintain some native pumping capacity, as the movement of blood due to the balloon is minimal. 

Bolooki, H., Balloon Pump Equipment, Chap. 6 in Bolooki, H., (ed). Clinical Application of the Intra-Aortic Balloon Pump, 3d ed., Futura Publishing, Armonk, N.Y., 1998a pp. 73-85. 

Kantrowitz, A., Freed, P. S., Cardona, R. R., Gage, K., Marinescu, G. N., Westveld, A. H., Litch, B., Suzuki, A., Hayakawa, H., Takano, T., Initial clinical trial of a closed loop, fully automatic intra-aortic balloon pump, ASAIO J., 1992 38(3) M617-M621. 

Mehlhom, U., Kroner, A., and de Vivie, E. R., 30 years clinical intra-aortic balloon pumping Facts and figures, Thorac. Cardiovasc. Surg., 1999 47(suppl 2) 298-303. 

Stavarski, D. H., Complications of intra-aortic balloon pumping. Preventable or not preventable , Crit. Care. Nurs. Clin. North. Am., 19% 8(4) 409-421. 

Circulatory assist device, ventricular assist device (VAD), intra-aortic balloon pump — eventual transplantation... 

Pinet, E. Pham, A. and Rioux, S. Miniature Fiber Optic Pressure Sensor for Medical Applications an Opportunity for Intra-Aortic Balloon Pumping (lABP) therapy. 17th Int. Conf. on Optical Fibre Sensors (OFS-17), Bruges, Belgium, SPIE-Vol. 5855 (2005), pp. 234-237... 

Intra-aortic balloon pump (lABP) is a mechanical device that increases myocardial oxygen perfusion in critically ill patients with cardiac diseases such as cardiogenic shock (CS), acute myocardial infarction (AMI), and ventricular arrhythutias. ... 

Parissis H, Soo A, Al-Alao B. Intra aortic balloon pump literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg November 2011 6. 

Vales L, Kanei Y, Ephrem G, et al. Intra-aortic balloon pump use and outcomes with current therapies. 7/wvarive Cardiol March 2011 23(3) 116-9. 

Mechanical devices are important and these include intra-aortic balloon pump and the development of the total artificial heart as exemplified by the Jarvik Mark 7. The artificial heart is placed inside the thorax, sutured to the recipient atria, pulmonary artery and aorta. It is completely mechanical with inlet and outlet valves, a smooth non-thrombogenic inner surface, elastic pumping balloons and an external power source. Difficulties include prolonged valve function, an appropriate non-clottable endocardial lining, a durable elastic pumping membrane, a reliable power source, a portable external power supply and infection of the machine-man interface. 

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