Aortic counterpulsation: A review of the hemodynamic effects and indications for use

Abstract

In the ever evolving field of cardiovascular medicine and coronary intervention, the intra-aortic balloon pump (IABP) is a mature technology, which still plays an important role. The balloon pump invasively supports patient hemodynamics by augmenting diastolic perfusion and increasing diastolic blood pressure, thereby increasing coronary perfusion and reducing afterload. Its efficacy has been demonstrated in a multitude of clinical situations, including acute coronary syndromes, high-risk coronary interventions, cardiogenic shock, and cardiovascular surgery. The potential complications of aortic counterpulsation are serious, although much lower than once feared. With proper patient selection, insertion technique, and management, the IABP is a powerful tool to assist in the treatment of patients with cardiovascular disease. This article will review the hemodynamics, indications, and complications associated with its use.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…983 Intraaortic balloon counterpulsation is an established mechanical cardiac support procedure that has been demonstrated to increase cardiac output and to improve coronary blood flow. 1025,1026 In several RCTs, its preoperative initiation and perioperative use have been shown to reduce the mortality rate in CABG patients who are considered to be at high risk (ie, those undergoing repeat CABG, those with an LVEF Ͻ30%, or those with left main CAD) 1022-1024 despite its known associated vascular complications. 1021 In contrast, its routine use in subjects who are not thought to be high risk has not been demonstrated.…”

Radiology of cardiac devices and their complications

“…53 Therefore, many authors recommend daily chest radiographs to confirm that the IABP remains in optimal position. 54 The IABP should be inserted such that the balloon tip is 2.5 cm distal to the left subclavian artery origin. If the IABP is placed too proximally, then it may occlude the brachiocephalic, left carotid or left subclavian arteries.…”

Cardiogenic shock in myocardial infarction-results of in-hospital follow-up

“…Mechanical cardiac assist devices enhanced hemodynamic stabilization [13,14] and enabled more percutaneous interventions that resulted in a marked improvement in the survival of CS patients. Only 7 of our patients (8%) underwent IABP.…”