Intraaortic balloon pumping in children

Background. Intraaortic balloon pump (IABP) usage in young children remains a rarity because, first, there is a widespread misconception that the grea ter elasticity of the aorta in children may prevent effective augmentation, and second, children in low cardiac output states are more likely to have associated right ventricular failure and pulmonary problems. We report our experience with the use of IABP in children undergoing cardiac surgery in w hom mechanical support was necessary for the treatment of refractory cardia c failure. Methods. Over a 3-year period, 14 children were identified as requiring IAB P support after cardiac surgery. Their median age was 3 years (range 7 days to 13 years) and their median weight was 13.3 kg (range 3.5-51 kg). Indica tions for IABP use were: failure to wean from cardiopulmonary bypass (5 pat ients), sudden deterioration in intensive therapy unit (ITU) (3 patients), progressive deterioration in ITU (4 patients), and prophylactic therapy for known poor preoperative ventricular function (2 patients). Results. Ten of 14 patients (71%) were successfully weaned from the IABP, o f whom 8 became long-term survivors (57%). Among the survivors, the mean du ration of IABP usage was 127 h (range 12-260 h), while for those who died w hile on IABP, the mean duration was 15 h (range 8-24 h). The most major IAB P-related complication encountered was mesenteric ischemia, which had a fat al outcome. Conclusions. IABP therapy, used as an adjunct to conventional medical treat ment, can give properly selected young children in refractory low cardiac o utput states after heart surgery a greater than 50% chance of long-term sur vival. (Ann Thorac Surg 1999;67:1415-20) (C) 1999 by The Society of Thoraci c Surgeons.