Percutaneous left ventricular assist device vs . intra-aortic balloon pump in patients with severe left ventricular dysfunction undergoing cardiovascular intervention: A meta-analysis.

Objective: Although controversial, the intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are widely used for initial hemodynamic stabilization. We performed a meta-analysis to compare the clinical outcomes of these two devices in patients with severe left ventricular (LV) dysfunction undergoing percutaneous coronary intervention (PCI) or ventricular tachycardia (VT) ablation.

Methods: MEDLINE, EMBASE, the Cochrane Registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs) and prospective observational studies. Meta-analysis was conducted using a random effects model.

Results: The quantitative analysis included 4 RCTs and 2 observational studies. A total of 348 patients received PLVAD and 340 received IABP. Meta-analysis revealed that early mortality rates (in-hospital or 30-day) did not differ between the PLVAD and IABP groups (relative risk ( RR ) = 1.03, 95% confidence interval ( CI ) = 0.70-1.51, P  = 0.89). Significant differences were observed between the two groups in the composite, in-hospital, non-major adverse cardiac and cerebrovascular events (MACCE) rate ( RR  = 1.30, 95% CI  = 1.01-1.68, P  = 0.04).

Conclusions: Compared with IABP, PLVAD with active circulatory support did not improve early survival in those with severe left ventricular dysfunction undergoing either PCI or VT ablation, but increased the in-hospital non-MACCE rate.