Intra-aortic balloon counterpulsation in decompensated cardiomyopathy patients: bridge to transplantation or assist device

Ieva Norkiene, Donata Ringaitiene, Kestutis Rucinskas, Robertas Samalavicius, Alis Baublys, Saulius Miniauskas, Vytautas Sirvydis
Interactive Cardiovascular and Thoracic Surgery 2007, 6 (1): 66-70

OBJECTIVES: The crucial decision to progress from pharmacological treatment of acute decompensated heart failure to institution of assist device or transplantation begins with evaluation of the chances for a successful recovery. We tested whether the intra-aortic balloon counterpulsation (IABP) could give us the necessary time for clinical decision-making and preserve adequate circulation until it is made.

METHODS: We assessed 11 dilated cardiomyopathy patients of NYHA class IV, listed for heart transplantation or a ventricular assist device (VAD), who had conventional IABP placed. Heart function prior to and after IABP insertion as well as hemodynamics, end-organ function (renal and hepatic), frequency of complications and clinical outcomes were assessed.

RESULTS: The duration of intra-aortic balloon pump insertion ranged from 72 to 360 h (mean 181.54+/-81.65). After 48 h of intra-aortic balloon pump support, there was a significant increase of mean systemic arterial pressure from 74.5+/-9.6 to 82.3+/-4.7 mmHg (P=0.02), and ejection fraction from 14.7+/-6.4 to 21.0+/-8.6 (P=0.014). Meanwhile improvement of cardiac index, pulmonary wedge pressure and end-organ perfusion markers did not reach statistical significance. Three patients were successfully weaned off the balloon and recovered without additional interventions, two patients were transplanted and three were supported with counterpulsation until the implantation of assist device. Three patients died due to progressive heart failure, two after IABP removal and one after VAD implantation. There was no incidence of infection, limb ischemia, thrombus, or embolic complications.

CONCLUSIONS: Our data showed that intra-aortic balloon pump support may be successfully and safely used in the acute decompensated dilated cardiomyopathy patients, as an urgent measure of cardiac support, to stabilize the patient and maintain organ perfusion until transplant is available, VAD is placed or patient is weaned from IABP.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"