Placement of intra-aortic balloon pump allows definitive biliary surgery in patients with severe cardiac disease.

This study reviews the cases of 15 patients with severe cardiac disease treated with the intra-aortic balloon pump (IABP) to improve cardiac status so that they could undergo definitive cholecystectomy. The 14 men and one woman ranged in age from 49 to 74 years. Indications for cholecystectomy included acute cholecystitis in nine patients and chronic cholecystitis in six patients. All patients had prior myocardial infarction, and in two patients this had occurred within 2 months of operation. All patients were Goldman's Class IV. Eight had severe cardiomyopathy. Mean ventricular ejection fraction was 21% +/- 3%. Cardiac index was 2.2 +/- 0.2 L/m/m2, and pulmonary artery pressure (PAP) was 51 +/- 5/23 +/- 2 mm Hg. After IABP placement, pulmonary wedge pressure decreased in all patients, from 24 +/- 3 mm Hg to 16 +/- 2 mm Hg (p less than 0.01). PAP systolic pressure decreased to 38 +/- 3 mm Hg (p less than 0.01), and PAP diastolic pressure decreased to 18 +/- 2 mm Hg (p less than 0.05). All patients had cholecystectomy. Five patients had intraoperative cholangiography. One of these five patients had a common bile duct exploration, and another underwent cystgastrostomy. Two patients died postoperatively of arrhythmias. Thirteen patients are alive 3 months to 7 years after operation, without biliary symptoms. Three patients have had orthotopic heart transplants. We conclude that IABP significantly improves cardiac performance so that many patients who have severe cardiac disease can undergo definitive biliary surgery.