33967 Insertion of intra-aortic balloon assist device, percutaneous

Name of the Procedure:

Insertion of Intra-Aortic Balloon Assist Device, Percutaneous
Common name(s): IABP Insertion, Intra-aortic Balloon Pump Insertion
Technical/Medical term: Percutaneous Insertion of Intra-Aortic Balloon Pump

Summary

Insertion of an intra-aortic balloon assist device is a procedure where a specialized balloon is inserted into the aorta through a small incision in the skin. The balloon helps the heart pump blood more effectively, particularly for patients dealing with severe heart conditions.

Purpose

This procedure is used to support the heart in conditions where it is not pumping adequately. It aims to improve blood flow, reduce the heart's workload, and ensure vital organs receive enough oxygen-rich blood.

Indications

• Severe heart failure
• Cardiogenic shock
• Post-cardiac surgery support
• Acute myocardial infarction (heart attack)
• Severe cardiac complications such as unstable angina
  #### Preparation
• Fasting for at least 6-8 hours before the procedure
• Adjustment or discontinuation of certain medications as instructed by a physician
• Diagnostic tests including blood work, ECG, and imaging studies such as echocardiography or chest x-ray

Procedure Description

1. The patient is typically administered local anesthesia and may receive mild sedation.
2. A small incision is made, usually in the groin area.
3. A catheter is inserted into a major artery, often the femoral artery.
4. The intra-aortic balloon catheter is advanced through the artery into the aorta.
5. The balloon is positioned just below the subclavian artery and is confirmed using imaging guidance.

6. The balloon inflates and deflates synchronously with the cardiac cycle to assist blood flow.

   Equipment: Intra-aortic balloon pump, catheter, imaging equipment for guidance (fluoroscopy or ultrasound)

Duration

The procedure usually takes 30 minutes to 2 hours.

Setting

The procedure is performed in a hospital, typically in a catheterization lab or an operating room.

Personnel

• Cardiologist or Cardiothoracic Surgeon
• Interventional Radiologist (if imaging guidance is required)
• Anesthesiologist or Nurse Anesthetist (for sedation or anesthesia)
• Specialized nurses and technicians

Risks and Complications

• Bleeding at the insertion site
• Infection
• Vascular injury
• Thrombosis (blood clots)
• Complications from anesthesia
• Device malfunction

Benefits

• Immediate support to the failing heart
• Improved blood flow to vital organs
• Reduced heart workload
• Potential stabilization of critical cardiac function while awaiting further treatment

Recovery

• Post-procedure monitoring in the Intensive Care Unit (ICU)
• Bed rest with limited movement to prevent dislodgment
• Follow-up imaging to confirm correct placement
• Gradual return to normal activities as advised by healthcare providers

Alternatives

• Medication management (e.g., inotropes, vasopressors)
• Surgical interventions like cardiac bypass
• Ventricular assist devices (VADs)
• Extracorporeal membrane oxygenation (ECMO)
  Pros and Cons: Medication management may be less invasive but may not be sufficient. Surgical interventions and VADs can be more invasive but might be necessary for long-term support.

Patient Experience

During the procedure, the patient may feel slight pressure or discomfort at the incision site. Post-procedure, there will be some discomfort from the insertion site, and they may feel the effects of reduced activity levels. Pain is usually managed with medications and comfort measures.