33970 Insertion of intra-aortic balloon assist device through the femoral artery, open approach

Name of the Procedure:

Insertion of intra-aortic balloon assist device through the femoral artery, open approach Common name(s): Intra-aortic balloon pump (IABP) insertion

Summary

This procedure involves the placement of an intra-aortic balloon pump (IABP) into the aorta via the femoral artery through a surgical incision. The IABP helps the heart pump more effectively by inflating and deflating in sync with the heartbeat.

Purpose

The procedure is used to treat severe heart conditions such as cardiogenic shock or severe heart failure. The goal is to improve blood flow and oxygen delivery to the heart and other organs, reducing the workload on the heart.

Indications

• Cardiogenic shock
• Severe left ventricular dysfunction
• Complications from acute myocardial infarction
• Support during high-risk cardiac procedures
• Bridge to heart transplantation or placement of a left ventricular assist device (LVAD)

Preparation

• Fasting for 6-8 hours before the procedure
• Medication adjustments as directed by the healthcare provider
• Pre-procedure tests: blood tests, electrocardiogram (ECG), echocardiogram, chest X-ray

Procedure Description

1. Under local or general anesthesia, an incision is made in the groin area to expose the femoral artery.
2. A catheter with a deflated balloon at its tip is inserted into the femoral artery and guided to the aorta.
3. The balloon is positioned in the descending aorta, just below the heart.
4. The balloon is connected to an external pump console that controls its inflation and deflation in sync with the patient's heartbeat.
5. The incision is closed and dressed.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital setting, often in a catheterization lab or operating room.

Personnel

• Cardiologist or cardiac surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologists

Risks and Complications

• Bleeding or hematoma at the insertion site
• Infection
• Vascular injury or limb ischemia
• Balloon rupture or malfunction
• Stroke or transient ischemic attack (TIA)
• Kidney damage due to decreased blood flow

Benefits

• Improved cardiac output and blood flow
• Stabilization of hemodynamic parameters
• Reduced symptoms of heart failure
• Potentially lifesaving in acute scenarios
• Can serve as a bridge to more definitive treatments

Recovery

• Initial recovery in an intensive care unit (ICU) for continuous monitoring
• Bed rest and limited physical activity
• Regular follow-up appointments and imaging to monitor device function and position
• Duration of IABP support varies based on patient condition

Alternatives

• Medical management with medications (e.g., inotropes, vasopressors)
• Other mechanical support devices (e.g., left ventricular assist device (LVAD))
• Surgical interventions like coronary artery bypass grafting (CABG)
• Heart transplantation

Patient Experience

During the procedure, the patient will be sedated and should not feel pain. Post-procedure, discomfort or soreness around the insertion site is common, and pain can typically be managed with medications. The patient's movements may be restricted initially to ensure the balloon catheter remains in place.