Clinical Publications

Initial Clinical Experience with a New Permanent Mechanical Auxiliary Ventricle: The Dynamic Aortic Patch. Kantrowitz, Adrian, Joseph S. Krakauer, Melvyn Rubenfire, Dov Jaron, Paul S. Freed, W. Welkowitz, Philip N. Cascade, Waldemar J. Wajszczuk, Marc Lipsius, M. Ciborski, Steven J. Phillips, and M. T. Hayden. Transactions - American Society for Artificial Internal Organs 18 (1972): 159-167

http://echo.gmu.edu/bionics/goldvol.htm

Treatment of Cardiogenic shock by Intraaortic Balloon Pumping. Results in 42 patients. A. Aris, J. Krakauer, S. Phillips, M. Ciborski, W .J. Wajszczuk, M. Rubenfire, Dov Jaron and A. Kantrowitz.. Actas del VI Congreso Europeo de Cardiologia, Madrid, Spain, 1972, (Published by Editorial Paz Montalvo, Madrid,  pp. 971-972, 1974).

Balloon pump treatment reversed the shock in 39 (93%) of the 42 patients. Of these, 27 (64%) regained circulatory stabilization allowing discontinuation of treatment and removal of the balloon. Fifteen (36%) died during treatment. Of the 27 patients regaining circulatory stabilization, 12 (28%) recovered completely and were discharged from the hospital. The causes of death among the 30 non-survivors included myocardial rupture in 13 patients.

The results suggest that this method of circulatory support is effective in treatment of patients in cardiogenic shock. Furthermore, the simplicity and safety as well as the hemodynamic effectiveness of this therapeutic modality indicates that balloon pumping may have potential role in other applications: 1)  Support before, during and after cardiac surgery.           2)  Improved  myocardial perfusion for angina pectoris. 3)  Circulatory support during coronary angiography or vetriculography. 4)  Prolonged term support in chronic left ventricular failure.

Intra-aortic phase-shift balloon pumping. Clinical applications. Aris A, Krakauer J, Phillips SJ, Ciborski MG, Rubenfire M, Wajszczuk WJ, Kantrowitz A. J Cardiovasc Surg (Torino). 1973; Spec No: 647-50.

Optimum results have been obtained in medically refractory cardiogenic shock. Sixty-six patients were treated with the intra-aortic counterpulsating balloon for the indications listed above. Shock was reversed in 39 (93%) of the 42 patients, and in 27 (64%) the resulting hemodynamic stabilization permitted the procedure to be discontinued. Twelve patients (28%) were discharged from the hospital.
Peri-operative support (open heart surgery) included: 5 high-risk patients with severe bi-ventricular failure, who were pumped pre-operatively and post-operatively, all showed hemodynamic improvement, 3 survived the procedures and 2 were discharged from the hospital; six patients were unable to be “weaned” from cardiopulmonary bypass - after insertion of the balloon, 4 were able to be taken of the bypass but only 1 was a long-term survivor.
Late post-operative complications developed in 2 patients. One of them with cardiac tamponade, sternal dehiscence and profound shock, underwent re-exploration under continuous balloon pumping. He recovered and was discharged from the hospital. The other patient experienced multiple hepatic and circulatory complications resulting in severe metabolic imbalance that culminated in death.
Severe congestive heart failure was treated in 4 patients. Two showed initially hemodynamic improvement but died 48 and 72 hours after initiation of pumping. The other 2 were pumped, at first continuously, later intermittently, for 35 days without deleterious effects despite the duration of pumping.
In 1 patient with gram-negative septicemia complicated by shock, pumping was ineffective and the patient succumbed.
Six patients in terminal chronic left ventricular failure underwent balloon pumping to evaluate their hemodynamic response in consideration of implantation of a permanent device. Two of them showed a good response and subsequently underwent successful implantation procedure.
Results indicate that balloon pumping is an effective form of temporary circulatory support in a variety of clinical situations involving left ventricular failure.

Current indications for mechanical circulatory assistance on the basis of experience

with 104 patients. Wajszczuk WJ, Krakauer J, Rubenfire M, Ciborsky M, Malinowski E, Kantrowitz A: (abstr) Am J Cardiol 33: 176, 1974

Neurological Abnormalities in the Leg(s) After Use of Intraaortic Balloon Pump. Honet, Joseph C., Waldemar J. Wajszczuk, Melvyn Rubenfire, Adrian Kantrowitz, and James A. Raikes. Archives of Physical Medicine and Rehabilitation 56, (August 1975): 346-352.

http://www.labmeeting.com/papers/author/wajszczuk-w

Six patients from a group of 39 who survived after treatment with the intraaortic balloon pump (lABP) had significant neurological deficits in one or both legs associated with the use of the lABP. The device was used in a group of 89 patients initially for cardiogenic shock but its use has been expanded for patients having the following conditions: preshock; severe congestive heart failure; refractory angina; and for those undergoing open-heart surgery. The six patients who had neurological sequelae had eight lABP insertions into the thoracic aorta through the femoral artery and had neurological abnormalities and/or electromyographic abnormalities in nine lower extremities ranging from a foot drop to almost total paralysis of the lower extremity. The pathophysiology of the neurological deficit is postulated to be an obstruction to blood flow, or thromboemboli, in the femoral artery.

Patient Selection for Cardiac Surgery in Left Ventricular Power Failure.  Philip N. Cascade, MD; Waldemar J. Wajszczuk, MD; Melvyn Rubenfire, MD; Stewart E. Pursel, MD; Adrian Kantrowitz, MD.  Arch Surg 110 (11):1363-1367, 1975

http://profiles.nlm.nih.gov/GN/B/B/D/K/_/gnbbdk.pdf

PAPER READ BEFORE THE 23RD SCIENTIFIC MEETING OF THE INTERNATIONAL CARDIOVASCULAR SOCIETY, BOSTON, JUNE 19-20, 1975 http://archsurg.highwire.org/cgi/content/abstract/110/11/1363

Nineteen patients in acute left ventricular power failure following acute myocardial infarction were given support with intraaortic balloon pumping and underwent cardiac catheterization. Hemodynamic response to diastolic augmentation, results of left ventriculography, and observations of selective coronary arteriography were evaluated to determine which patients could survive without operation, which would require operation to survive, and which could be predicted not to survive operation. Of ten patients who underwent operation, three were long-term survivors. Two patients predicted to have a good prognosis without surgery did survive. Of three patients who had been determined to require operation but not undergo it, two died in the hospital and one a month later. The four patients whose conditions were considered inoperable died in the hospital. The results indicate that current methods of predicting the need for corrective surgery are relatively accurate and that the rate of survival in surgically treated patients may be increased.

Physiologic and angiographic evaluation of severe left ventricular power failure to determine feasibility of cardiac surgery. Proceedings;  Cascade PN, Wajszczuk WJ, Rubenfire M, Pursel S, Kantrowitz A. J Cardiovasc Surg (Torino). 1976 Jan-Feb;17(1):88.

THE CHEST X-RAY IN ACUTE LEFT VENTRICULAR POWER FAILURE:

AN AID TO DETERMINING PROGNOSIS OF PATIENTS SUPPORTED BY

INTRAAORTIC BALLOON PUMPING. PHILIP N. CASCADE, ADRIAN KANTROWITZ, WALDEMAR J. WAJSZCZUK AND MELVYN RUBENFIRE.

Am JRoentgenol 116:1147-1154, 1976

Serial chest x-rays were used as a means of evaluating the hemodynamic status of 43 patients in acute left ventricular power failure (LVPF) complicating acute myocardial infarction who were assisted with balloon pumping. The following find­ings were reported:

1. In patients with acute myocardial infarction, prediction of the hemodynamic status on the basis of chest x-rays is less reliable when severe LVPF is present as a complication.

2. The incidence and severity of roentgenographic findings of congestive heart failure and pulmonary edema are increased in patients with severe LVPF compared to patients with uncomplicated myocardial infarction.

3. Improvement in the roentgenographic degree of heart failure with positive clinical and hemodynamic responses to 24 hr or less of balloon pumping is an indica­tion that patients in severe acute LVPF may survive. Patients with deteriorating or unchanging chest x-ray findings have an extremely poor prognosis. These patients should be evaluated by cardiac catheterization and coronary arteriography to deter­mine the appropriateness of emergency surgical correction.

Intraaortic Balloon Pumping 1967 Through 1982: Analysis of Complications in 733 Patients. Kantrowitz, Adrian, Tarik Wasfie, Paul S. Freed, Melvyn Rubenfire, Waldemar J. Wajszczuk, and M. Anthony Schork. The American Journal of Cardiology 57 (15 April 1986): 976-983

http://www.labmeeting.com/papers/author/wajszczuk-w

Between June 1967 and December 1982, 872 attempts at intraaortic balloon pumping (IABP) were made in 733 patients. Nearly 75% of the patients were men; the proportion of women has increased in recent years. The principal indication for IABP support initially was cardiogenic shock, but over the years, preoperative support, weaning from cardiopulmonary bypass and unstable angina have become the primary indications. Complications of IABP were classified and distributed by severity (minor: I [15%] and II [26%]; major: III [3%] and IV [1%]) and type ([vascular [22%], infectious [22%], and bleeding [7%]). Vascular complication rates were higher in women (32 vs 18%; p = 0.0001), in diabetic patients (32 vs 20%, p = 0.003), and in hypertensive patients (27 vs 20%, p = 0.02). These did not vary with the duration of IABP support (range of duration 0 to 76 days). The rate of infectious complications was related to location where IABP was performed (coronary care unit 26%, operating room 12%). The rate of fever and bacteremia increased significantly with duration of IABP support, but the rate of local wound infection did not. In conclusion, most IABP complications are minor, resolve after balloon removal, are related to vascular status of the patient and, with the exception of bacteremia, are independent of IABP duration.

Risks associated with intraaortic balloon pumping in patients with and without diabetes mellitus. Wasfie, T : Freed, P S : Rubenfire, M : Wajszczuk, W : Reimann, P : Brozyna, W : Schork, M A : Kozlowski, J : Kantrowitz, A.  Am-J-Cardiol. 1988 Mar 1; 61(8): 558-62 

http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=269401

http://www.labmeeting.com/papers/author/wajszczuk-w

Between 1967 and 1982, intraaortic balloon pumping (IABP) was attempted in 733 patients. Of these, 132 were diabetic: 51 patients were managed with diet alone, 46 patients took oral hypoglycemic agents and 35 patients required insulin. Vascular complications associated with IABP occurred in 34% of the insulin-dependent diabetics, in 18% of other diabetics and in 14% of nondiabetic patients. Infectious complications were 37, 22 and 25%, respectively. Seventy-five diabetic patients (57%) were discharged alive from the hospital after balloon pumping, essentially the same proportion as among nondiabetic patients (58%). It is concluded that although diabetics incur a higher complication rate, IABP is not contraindicated.