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J Thorac Cardiovasc Surg 1998;115:1393
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Air embolism with intraaortic balloon counterpulsation during cardiopulmonary bypass

R. Unnikrishnan Nair, MS, FRCS

Reply to the Editor:

I thank Kurusz, Lick, and Conti for highlighting the potential dangers of air embolism with the use of the intraaortic balloon (IAB). I agree with their comments regarding the suction generated by deflation of the IAB. Fortunately, my colleagues and I have not had such incidents in the past 10 years and, like the authors, would recommend that the IAB be turned off temporarily while the aortic cannulas used for cardioplegia and bypass are being inserted or removed. Temporary cessation of ballooning lowers blood pressure while the aortic clamps are being applied. We have not used the IAB in any of the patients who had circulatory arrest. We would, however, agree with the suggestion that the IAB should be left deflated during the total circulatory arrest period. Full recirculation and deairing of the aorta should be effected before the IAB is used while the patient is being rewarmed. This is an important message for those using continued IAB counterpulsation during cardiopulmonary bypass.

Department of Cardiothoracic SurgeryYorkshire Heart CentreLeeds General Infirmary, Great George St.Leeds LS1 3EX, United Kingdom





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