Ambulatory intraaortic balloon pump use as bridge to heart transplant.

BACKGROUND: This study evaluates a modification of an ambulatory intraaortic balloon pump (IABP) technique used in patients with heart failure of ischemic origin for bridge to transplant. METHODS: In this retrospective review we evaluated the ability to place the ambulatory IABP, any complications, time on device, and success in bridging to transplant on the ambulatory IABP device. In addition, the cost as compared to current ventricular assist devices was determined. RESULTS: Between July 2000 and November 2001, 4 patients have been managed with ambulatory IABP in our combined University of Wisconsin and William S. Middleton Veterans Administration programs. All 4 patients had ischemia as their mode of heart failure, and each had a relative contraindication to standard ventricular assist device use. All 4 patients had ambulatory IABPs successfully placed through the left axillary artery without complication, and were able to ambulate early after ambulatory IABP placement, and increased their rehabilitation status before transplantation. Ambulatory IABP support ranged from 12 to 70 days. All 4 patients have been successfully transplanted and discharged from the hospital. Use of the ambulatory IABP support, even with multiple replacements, translated to 10- to 50-fold savings for each of the reported patients versus standard ventricular assist device use. CONCLUSIONS: As a result of our initial experience, we believe that ambulatory IABP is an excellent mode of support in selected patients, and is cost-effective, as compared to conventional ventricular assist device therapy.

Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery.

The present prospective study was designed to determine the prevalence of pleural effusion at approximately 28 days after cardiac surgery and their subsequent course. This consecutive case study included 389 patients; 312 had only coronary artery bypass graft surgery (CABG) surgery, 37 had both valve and CABG surgery, and 40 had only valve surgery. Chest radiographs were obtained approximately 28 days postoperatively. Patients were subsequently contacted by telephone 3, 6, and 12 months postoperatively and questioned about the presence of fluid in their chest and related symptoms. The prevalence of pleural effusions in the patients undergoing only CABG surgery (63%) or CABG surgery plus valve surgery (62%) was significantly (p = 0.05) higher than that in the patients undergoing valve surgery only (45%). The prevalence of effusions occupying more than 25% of the hemithorax was 9.7%. The primary symptom associated with these larger effusions was dyspnea. Chest pain and fever were uncommon. Over the 12-month follow-up, the effusions tended to resolve. In conclusion, the prevalence of pleural effusions occupying more than 25% of the hemithorax is approximately 10%, 28 days postoperatively. These larger pleural effusions produce dyspnea but not chest pain or fever, and most of the effusions disappear gradually over the subsequent months.