Mechanical left ventricular support using a 50 cc 8 Fr fibre-optic intra-aortic balloon technology: a case report.

INTRODUCTION: More than four decades have passed since the first clinical use of an (IABP) to improve the clinical scenario for patients with chronic left ventricular failure. The original IAB catheter size was 15 French (Fr), requiring an open surgical insertion and removal. This therapy has now become the most widely used mechanical device for failure of the left ventricle. The introduction of an 8 Fr fibre-optic IAB catheter with a 50 cc diastolic blood volume displacement has further increased the potential clinical impact of this technology. This new catheter can be used for all patients over 162 cm in height, allowing a broader spectrum of patients to benefit from increased diastolic blood volume displacement and fibre-optic pressure monitoring. The catheter has been designed on an 8 Fr shaft platform, potentially reducing the incidence of vascular complications. We present our case report on the world's first implant of this 50cc 8 Fr IAB catheter. CASE REPORT: Cardiac investigations on a 53-year-old man showed the patient to have ischaemic dilated cardiomyopathy with a left ventricular ejection fraction (LVEF) of 25%. An 8 Fr 50cc Sensation PlusTM IAB catheter was inserted pre-operatively, prior to coronary artery bypass grafting. RESULTS: The world's first insertion of this 8 Fr 50 cc IAB catheter was a complete success, with no complications. The patient's pre-, peri- and post-operative courses were as we expected and event free, underpinned by IABP support. CONCLUSION: This new 50 cc, 8 Fr IAB expands the patient group that can benefit from greater diastolic blood volume delivery, improved distal perfusion, more accurate monitoring, subsequent better beat-per-beat support and, finally, the reduced complication rates associated with an 8 Fr shaft.

Fiber-optic intra-aortic balloon therapy and its role within cardiac surgery.

INTRODUCTION: The patient population has changed and the cardiothoracic team are now operating on patients with more co-morbidity. One of the significant aspects of this increased co-morbidity, which affects both short- and long-term outcomes, is compromised left ventricular function. Intra-aortic balloon pump (IABP) technology offers these patients and the cardiac team an easily accessible, cost-effective, mechanical assist device. Arterial pressure monitoring for IABP therapy: Fluid-filled transducers used to measure the aortic waveform can be unreliable and inconsistent. Fiber-optic manometers located in the very tip of the IAB catheters provide accurate and fast, high quality measurements. This, in turn, presents the opportunity for the hardware and algorithm to measure key markers on the arterial waveform and optimise left ventricular support. It also provides the potential for automatic in vivo calibration, further increasing the accuracy and quality of the IAB support. The effect of fiber-optic IABP therapy on clinical management: A dual centre prospective audit comparing fluid-filled versus fiber-optic arterial pressure monitoring showed a 96% reduction in IAB-related perfusion on-site call-outs (17 vs. 1, respectively) and a 94% reduction in sub-optimal timing (55/98 vs. 2/94, respectively). CONCLUSION: The improved timing algorithms utilise the pressure information received 50 msecs faster than with fluid-filled transducers, measuring key markers on the pressure waveform and adjusting inflation and deflation accurately on a beat per beat basis. Fiber-optic IAB technology and, specifically, these improved algorithms provide better beat per beat mechanical support. Given our evolving patient population, this technology will not only play an increased role, but will have a significant impact on cardiac surgery.

Total miniaturized cardiopulmonary bypass: the next step in minimally invasive aortic valve replacement.

Minimally invasive aortic valve replacement has been established in many centres over the last decade. Although numerous modifications have been described to date, these solely involve variations of the utilized operative incision. Total miniaturized cardiopulmonary bypass (tMCPB) offers the theoretical potential of reducing even further the overall procedural "invasiveness". We describe our initial experience of an application of MCPB for aortic valve replacement through a minimal incision.

Miniature cardiopulmonary bypass--the Hammersmith experience.

The decision to embark on a miniature cardiopulmonary bypass programme requires careful planning. The objective of this paper is to present our experience and initial findings for consideration by our multidisciplinary peers, who may wish to implement this technology at their own hospitals. The paper reviews the evolution of our programme over the first 150 clinical cases and our current position on the advantages and disadvantages of miniature cardiopulmonary bypass.