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• W1569109725 abstract "Several discoveries and inventions in medicine have revolutionized it’s practice. Examples would include the discovery of Insulin by Dr William Banting in 1920. The discovery of Heparin by Dr Jay McLean and its first clinical use in Toronto in 1933-36, the advent of the membrane oxygenator, heart lung machines with progressively smaller footprints, intra aortic balloon (IAB) pumps and VAD’s (ventricular assist device) would be some of the devices which significantly impacted outcomes in cardiac surgery. The fundamentals of IAB technology were first tested by Harken in 1958, who is credited with the first use of diastolic augmentation. The pump for Harken’s system was a failure due to massive hemolysis. Moulopoulous (in the 1960’s) from the Cleveland Clinic developed the first successful prototype of an Intra-aortic balloon pump (IABP) which could be timed to the cardiac cycle. The IABP device as we know it was reported by Dr Adrian Kantrowitz (Fig 1) and his team from Grace Sinai hospital in Detroit. The first clinical implant was performed at Maimonides Medical Centre, Brooklyn, NY in Oct 1967 for a 48 yr old woman in cardiogenic shock unresponsive to traditional therapy. The IAB was inserted through a cut down of the left femoral artery (LFA) and pumping performed for 6 hrs. The shock was reversed and the patient discharged. The device was further developed for cardiac surgery by Dr David Bregman at New York Presbyterian Hospital in 1976. Studying the history of counterpulsation elucidates the great strides in IAB technology and its clinical applications. The size of the balloons initially inserted were as large as 15 Fr. Two operations were required for balloon usage, one to insert the balloon by cut down in a femoral artery, and a second operation to remove the balloon. Advances in technology afforded progressively smaller IAB catheter sizes and eventually 8 and 9Fr. balloons were developed. Current IAB catheter sizes are 7 and 7.5Fr. In 1968 –Kantrowitz and his group began to use the IABP regularly in clinical practice. Since 1979 balloon placement utilizes the Seldinger (percutaneous) technique. The wrapped IAB was developed in 1985. Advances in technology facilitated graduating from cut down insertions to percutaneous and sheathless insertions going from cut down insertions to percutaneous and finally sheathless insertions. Smaller diameter catheters permitted this along with user friendly consoles with automated and real time timing algorithms." @default.
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• W1569109725 date "2012-02-29" @default.
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• W1569109725 title "Intra-Aortic Balloon Counterpulsation Therapy and Its Role in Optimizing Outcomes in Cardiac Surgery" @default.
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• W1569109725 doi "https://doi.org/10.5772/28617" @default.
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