Cor Vasa 2003, 44(7-8):360-365
Intra-aortic balloon contrapulsation and its role in the management of heart failure
- Kardiochirurgická klinika, Fakultní nemocnice a Lékařská fakulta Univerzity Karlovy, Hradec Králové, Česká republika
Aim:
To evaluate the experience with intra-aortic balloon contrapulsation (IABP) in a department of cardiac surgery and in catheterization room.
Method:
The indication for IABP following cardiac surgery is low cardiac output and severe acute ischemic myocardial lesions refractory to conservative therapy. Prior to surgery, IABP is instituted in patients with at least two of the following risk factors: ejection fraction (EF) < 20%, unstable angina (UA), re-do surgery, left main coronary artery stenosis > 70%, or hemodynamic circulatory support before the procedure.
In the catheterization room, IABP is used in percutaneous coronary intervention (PCI) in patients in cardiogenic shock, and prior to an elective procedure in patients with an EF < 20% and diffuse coronary artery bed lesions in cases where only the artery selected for procedure is patent.
Group of patients:
A total of 5,989 cardiac surgery procedures were performed from September 1994 through August 2002 at the Department of Cardiac Surgery in Hradec Králové. IABP was employed in 178 cases (3%). In the catheterization room, IABP in PCI was used in a total of 41 cases since 1997.
Results:
Out of a group of 178 patients receiving IABC after cardiac surgery, treatment was successful in 94 patients (52.8%). 84 patients (47,2%) died. Contrapulsation time ranged from 1 to 122 hours. In 5 cases (2.8% of the 178-member group), IABP was instituted already before the procedure.
In the catheterization room, IABP was used in 41 patients, with 27 of these during PCI with acute myocardial infarction (MI) in cardiogenic shock. Treatment was successful in 14 patients (51.8%) while 13 (48.2%) died. The method was undertaken before an elective procedure in 14 cases. The intervention associated with risk was survived by 12 patients (85.7%) whereas 2 died (14.3%).
IABP-related complications included ischemic complications in 11 cases (5.1%) including major bleeding at injection site in 6 cases (2.7%), femoral and iliac artery dissection in two (0.9%), and iliac artery perforation in one case (0.4%). Fasciotomy was required in two cases (0.9%), femoro-femoral vascular reconstruction and below-knee amputation in one case each (0.4%).
Thrombocytopenia was noted in 18 cases (8.2%). Technical complications included balloon rupture and device malfunction due to obstruction in gas tubing in two cases each (0.9%).
Conclusion:
IABP has an irreplaceable role in interventional treatment of acute heart failure and is a successful method for providing support in circulatory failure. However, it is associated with relatively high rates of complications of varying severity. The effect of treatment and the complication rates in our group of patients were consistent with data reported in the literature.
Keywords: Intra-aortic balloon contrapulsation; Cardiac surgery; Percutaneous coronary intervention; Heart failure
Published: July 1, 2003 Show citation