Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation

Background. Right ventricular failure from elevated pulmonary vascular resi stance in the recipient is a main cause of early mortality after heart tran splantation. When pharmacologic treatment is insufficient, mechanical circu latory assistance has been used to support the failing right ventricle. Con sidering right and left ventricular interdependence, we investigated whethe r intraaortic balloon counterpulsation (IABP) might also alleviate predomin antly right ventricular dysfunction after heart transplantation. Methods. Among 278 cardiac recipients, 12 adult patients underwent mechanic al circulatory support for cardiac allograft dysfunction. Five patients wer e treated with percutaneous IABP for early postoperative low cardiac output syndrome characterized by predominantly right ventricular failure. Clinica l data and hemodynamic Variables were recorded before and during IABP treat ment. Results. Cardiac index (CI) and mean arterial pressure (MAP) increased (CI 1.7 +/- 0.1 to 2.5 +/- 0.2, MAP 53 +/- 12 to 71 +/- 7, p < 0.05) within 1 h our after IABP, whereas central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) decreased (CVP 21.6 +/- 1.7 to 13.8 +/- 3.1, p <.05; PAWP 14.8 +/- 4.9 to 12.4 +/- 3.7, nonsignificant). Within the next 12 hour s, CI and mixed venous oxygen saturation increased (p < 0.05) and pulmonary artery pressure decreased (p < 0.05). All 5 patients were weaned successfu lly and 4 are long-term survivors with adequate cardiac performance at 1 ye ar follow-up. Conclusions. Intraaortic balloon pumping is a minimally invasive circulator y assist device with proved efficiency in low cardiac output syndromes. Thi s report shows that low output syndrome caused by predominantly right ventr icular allograft failure may be an additional indication for IABP. (Ann Tho rac Surg 2000;70:1587-93) (C) 2000 by The Society of Thoracic Surgeons.