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PubMedDate not supplied

Assessment of intra-aortic balloon counterpulsation in cardiogenic shock.

Intra-aortic balloon pumping (IABP) has been shown to reverse the cardiogenic shock syndrome, but the long-term results (16 to 53% survival) have, in general, been disappointing. The most productive areas for the use of IABP are in the treatment of acute myocardial ischemia where in one report of 16 patients treated with IABP and surgery 15 survived and 13 were angina free, and in the open heart surgical setting where survival ranges from 42 to 70%. The implications of these treatment modalities are discussed.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Elective intraaortic balloon counterpulsation in high-risk off-pump coronary artery bypass grafting.

The beneficial effects of intraaortic balloon pump (IABP) in CABG with cardiopulmonary bypass (CPB) have been reported. However, the benefits of insertion of IABP electively in high-risk off-pump coronary artery bypass grafting (OPCAB) have not been established. Six hundred and twenty-five patients who underwent OPCAB form the study group. High-risk patients fulfilling two or more of the following: left main stem stenosis >70%, unstable angina, and poor left ventricular function, who had elective insertion of IABP preoperatively by the open technique (group I; n = 20) were compared with a similar high-risk group that did not (group II; n = 25). There were no significant differences in risk factors between the two groups (Euroscore 5.68). The mean number of grafts was similar. Postoperatively, there were no significant differences in the need for inotropes, duration of ventilation, arrhythmias, cerebrovascular, gastrointestinal, and infective complications (p = NS). There were no IABP-related complications. Acute renal failure requiring hemofiltration was higher in group II (n = 5; p < 0.05). Four patients (16%) in group II required postoperative IABP. Although intensive care stay was longer in group I (27.6 +/- 15.3 vs. 18.6 +/- 9.1 hours; p < 0.05), patients in group I were discharged earlier from hospital. There was no difference in mortality between the two groups (n = 1 in each group). In high-risk patients undergoing OPCAB, routine preoperative insertion of IABP electively reduces the incidence of acute renal failure. In addition it avoids the need for emergency insertion postoperatively and may result in earlier discharge.

Acute Kidney Injury↗
PubMed1994

Role of intra-aortic counterpulsation in cardiogenic shock and acute myocardial infarction.

IACP has played an important role in the evolution of the therapy of cardiogenic shock. Although IACP has not developed to an independent treatment modality, it is an essential adjunct to facilitate early catheterization and reperfusion strategies. With this combined approach, hospital and long-term survival rates have reached encouraging results. In acute myocardial infarction, IACP may evolve into an intriguing adjunct to thrombolysis and/or PTCA. Preliminary data suggest that IACP might decrease the rate of reocclusion and reinfarction after thrombolysis and/or PTCA and, thus, interrupt the vicious cycle of infarct extension, development of left-ventricular failure and cardiogenic shock. Further research is in progress.

Adult↗