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J Thorac Cardiovasc Surg 2006;131:1382-1389
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Intra-aortic balloon pumping in children undergoing cardiac surgery: An update of the Liverpool experience

Georgios Kalavrouziotis, MD, PhD a , * , Ajith Karunaratne, MD, MRCS a , Shahzad Raja, MD, MRCS a , Giovanna Ciotti, MD b , Manoj Purohit, MD, FRCS a , Antonio F. Corno, MD, PhD, FRCS, FECTS, FAATS a , Marco Pozzi, MD, FRCS, FECTS a

a Department of Pediatric Cardio-Thoracic Surgery, Royal Liverpool Children's NHS Trust, Alder Hey Hospital, Liverpool, United Kingdom.
b Department of Pediatric Cardiology, Royal Liverpool Children's NHS Trust, Alder Hey Hospital, Liverpool, United Kingdom.

Received for publication December 5, 2005; revisions received February 19, 2006; accepted for publication February 24, 2006.

* Address for reprints: Georgios Kalavrouziotis, MD, PhD, Royal Liverpool Children's Hospital, Pediatric Cardio-thoracic Surgery, Eaton Rd, Liverpool L12 2AP, United Kingdom. (Email: gkalavrouziotis{at}yahoo.com).

OBJECTIVE: Intra-aortic balloon pumping in children remains a rarity. We report our experience in supporting pediatric cardiac surgical patients with intra-aortic balloon pumping.

METHODS: We reviewed the cases of 24 children supported with intra-aortic balloon pumping after cardiac surgery in our institution from 1994 through 2003.

RESULTS: Mean age at the time of the operation was 5.0 ± 5.6 years (range, 7 days-17.5 years). Ten patients were infants less than 6 months old. Mean weight was 18.9 ± 18.1 kg (range, 3.5-58.7 kg). Indications for intra-aortic balloon pump deployment were postoperative hemodynamic deterioration (n = 11, 8 survivors), failure to wean off cardiopu(n = 7, 5 survivors), and prophylaxis before weaning off cardiopulmonary bypass (n = 6, 5 survivors). The balloon was inserted through the ascending aorta in infants and through the femoral artery in children. Eighteen children (7 infants) were weaned off the intra-aortic balloon pump successfully (intra-aortic balloon pump survival, 75%). Mean duration of intra-aortic balloon pump support was 121.3 ± 140.60 hours (range, 8-670 hours). There were 3 post–intra-aortic balloon pump in-hospital deaths (survival to hospital discharge, 62.5%). Severe intra-aortic balloon pump–related complications were mesenteric ischemia in 1 patient and lower limb ischemia requiring intra-aortic balloon pump removal in 1 patient. At a mean follow-up of 85 ± 31 months (range, 18-124 months), all 15 long-term survivors were alive and well.

CONCLUSIONS: Use of an intra-aortic balloon pump is an effective modality of cardiac support in properly selected pediatric cardiac surgical patients with refractory low cardiac output. It can be safely used in small infants and neonates. In selected cases with known left ventricular dysfunction, there is a place for prophylactic use of an intra-aortic balloon pump.

Abbreviations and Acronyms ALCAPA = anomalous left coronary artery originated from the pulmonary artery; BW = body weight; CPB = cardiopulmonary bypass; ECG = electrocardiogram; ECMO = extracorporeal membrane oxygenation; IAB = intra-aortic balloon; IABP = intra-aortic balloon pumping; ICU = intensive care unit; LV = left ventricular; PS = pulmonary stenosis; VAD = ventricular assist device




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S. Paul Collison and K. Singh Dagar
The role of the Intra-aortic balloon pump in supporting children with acute cardiac failure
Postgrad. Med. J., May 1, 2007; 83(979): 308 - 311.
[Abstract] [Full Text] [PDF]


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