Toktas Faruk, Yavuz Senol, Eris Cuneyt, Surer Suleyman
Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, 16330 Bursa, Turkey.
ScientificWorldJournal. 2014 Jan 2;2014:247803. doi: 10.1155/2014/247803. eCollection 2014.
Intra-aortic balloon pump (IABP) is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases.
This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum.
The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0 ± 13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft.
This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.
主动脉内球囊反搏（IABP）是心脏手术高危患者血流动力学支持中应用最广泛的机械辅助装置。我们研究的目的是证实经主动脉途径是否是严重主髂动脉疾病患者进行IABP置入的合适替代方法。
本研究纳入7例因严重冠状动脉疾病合并严重主髂动脉疾病而接受冠状动脉旁路移植术的患者。这些患者无法脱离体外循环，需要IABP支持，通过升主动脉置入IABP。在部分阻断钳夹下，将IABP导管通过与升主动脉端侧吻合的单独大隐静脉移植间接插入，并推进至降主动脉的所需位置，然后引出至颈部皮下组织。
所有患者手术均成功进行。IABP支持的平均持续时间为54.0±13.4小时。没有与经主动脉途径相关的院内死亡和并发症。移除IABP不需要再次开胸。术后6个月，多层CT检查显示大隐静脉移植残余处有血栓形成。
对于无法采用逆行股动脉途径的严重主髂动脉疾病患者，该技术是一种简单、可靠且可重复的选择。
