**14. Relative contraindications for IAB insertion**


52 Special Topics in Cardiac Surgery

12. Myocardial ischemia or stunning of the heart- In this scenario much of the myocardium has suffered reversible damage and scarring has occurred only in a portion of the heart. 13. VSD (ventricular septal defect) - particularly post MI. This may be accompanied by

14. Support in the General OR for patients with ongoing heart disease or a history of heart

Freedman coined the term "Myoconservation" (*Quaal 1993*). It is defined as the hemodynamic support provided within the crucial window of opportunity, ensuring that enough myocardium remains viable to permit normal function of the heart following definitive coronary therapy-whether it be CABG or coronary stenting/PTCA. The IAB is one of the very important modalities available to the cardiac surgeon/cardiologist which supports myoconservation by supporting the coronary circulation, supporting the systemic

Miller et al in 1986 summarize "The result of our clinical experience suggest that more aggressive use of IAB is likely to save lives of coronary disease patients who develop severe complications of their disease. There have been no deaths reported among our patients with refractory unstable angina who had an IAB inserted and all evidence suggests that short of actually opening the vessel to obtain relief from angina, IAB insertion is the most effective

More recent studies (*Christenson JT 1999*) have confirmed the efficacy of pre-operative IAB

1. Aortic regurgitation or insufficiency. In this physiology, raising AEDP would result in increase of regurgitant factor thereby increasing workload of the heart. In instances of

mild AI a decision can be made if the benefits outweigh the risks.

Fig. 10. BENCHMARK for IAB use (2005)

17. Cardiac contusion and/or trauma 18. Septic shock or pre-shock syndrome

method to treat these patients"

use in high-risk coronary patients.

19. Pulsatile flow (*Onorati F et al.,2009*)during CPB

disease

16. Left main disease

papillary muscle rupture and acute mitral regurgitation

15. Transport (*Sinclair TD & Verman HA,2009)*for unstable patients

circulation, reduction in LV stress and reduction in LV workload.

**13. Absolute contraindications for IAB insertion** 

