Background:
Intraaortic balloon counterpulsation (IABC) with the larger volume (LV) 50 cc
Mega
balloon offers greater aortic diastolic augmentation and systolic unloading than its 40cc predecessor. We retrospectively analyzed our single center tertiary care experience with 150 consecutive patients (pts) with LV IABC to gauge its efficacy and safety.
Methods:
Retrospective chart review for demographic, procedural, safety and in-hospital outcome data was undertaken on 150 pts. In 64 pts, hemodynamic data by Swan was available pre- IABC, and 4, 24, and 48 hours during IABC.
Results:
LV IABC was deployed for cardiogenic shock and/or CHF (n=128), coronary ischemia (n=11), or high risk PCI/surgery (n=11): Mean age 58±15 with 18% over age 80, 21% female, 36% % African-American. The median LVEF was 22% (15.3%-33.2%) and 37% were non-ischemic myopathy. 19% of IABC insertions were emergent at bedside without fluoroscopy. Median duration of IABC was 92 hrs (48hrs-235 hrs) during which a leak or poor augmentation developed in 3%. 3(2%) pts had major vascular complications; 3(2%) pts had major bleeding. 51(34%) pts escalated from IABC to Impella, LVAD, or heart transplantation. Overall, in-hospital mortality was 27%. In the subgroup of 100 pts in whom IABC was the initial therapy for cardiogenic shock mortality was only 32%. Hemodynamic data (64 pts) pre-IABC vs 48 hrs: Aortic systolic pressure decreased (mean systolic unloading) -10.7 +/-25 mmHg; absolute Aortic diastolic pressure (augmented dias AoP) 108 ± 22mmHg; mean PA decreased -5.4±11; mean RA -3.2±6 (all p <0.05). Cardiac output and index increased by of 0.7±1.6 l/min, and 0.4±0.8 l/min/m2 respectively (p<0.005).
Conclusion:
LV IABC with the 50cc
Mega
balloon is a safe first line percutaneous support strategy in critically ill pts with easy bed-side deployment and relatively few device related complications. Despite conflicting results from clinical trials, we observed, a significant improvement in hemodynamic indices in a broad range of pts with relatively few vascular and bleeding complications with IABC. Among the 100 pts in whom IABC was the initial ventricular assist therapy for cardiogenic shock, survival to hospital discharge was 68%.
Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan – patient characteristics and predictors of in-hospital mortality