Complications of intra-aortic balloon counterpulsation.The role of catheter size and duration of support in a multivariate analysis of risk

Scholz, K. H.; Ragab, Sameh M.; Mühlen, Friederike von zur; Schröder, T.; Werner, Gerald S.; Mindel, L.; Kreuzer, H

doi:10.1053/euhj.1997.0802

Cited by 43 publications

(28 citation statements)

References 24 publications

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“…The ischemia of lower limbs, related to the insertion site, and thrombocytopenia are the most frequent complications observed with the use of IAB 30 . These complications are mainly related to the diameter of the balloon-catheter, the time of counterpulsation use, prolonged hypotension periods and the presence of previous vasculopathy.…”

Section: Discussionmentioning

confidence: 99%

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave

Kern¹,

Sant'Anna²

2006

Arq. Bras. Cardiol.

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OBJECTIVETo evaluate the effectiveness of prophylactic intra-aortic balloon (IAB) in elective myocardial revascularization surgery (MRS), to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODUsing a cohort study model, 239 patients with left ventricular ejection fraction ≤40%, submitted to elective MRS with extracorporeal circulation (ECC) were evaluated from March 1995 to February 2001. RESULTSOf these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group). The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were fi ve demises (8.6%) in the group with IAB and 21 (11.6%) in the control group (non-signifi cant difference). There were 2 (3.4%) infarctions in the IAB group and 28 (15.5%) in the control group (p< 0.05), relative risk of 0.22 with an interval of confi dence of 95% from 0.05 to 0.85. CONCLUSIONThe use of pre-operative IAB can signifi cantly reduce the risk of trans or post-operative acute myocardial infarction (AMI) in patients with decreased systolic function, without increasing vascular complications. In this same situation, the IAB does not signifi cantly decrease mortality. Randomized studies are necessary to establish more precise conclusions.

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Section: Discussionmentioning

confidence: 99%

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave

Kern¹,

Sant'Anna²

2006

Arq. Bras. Cardiol.

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“…Severe peripheral vascular disease represents the most important risk factor for vascular complications which, in turn, constitute the largest proportion of all IABP-related complications [16,[18][19][20][21][22].…”

Section: Contraindicationsmentioning

confidence: 99%

Intra-Aortic Balloon Counterpulsation in Contemporary Practice – Where Are We?

White

Ruygrok

2015

Heart, Lung and Circulation

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“…Durch die Einfª der perkutanen Implantation mittels modifizierter SeldingerTechnik zu Beginn der 80er Jahre [6] und durch die Verbesserung des Kathetermaterials mit Reduktion der Katheterdicke von anfangs 14 F auf zuletzt 8,0 F (wahlweise schleusenlose Implantationstechnik [43]) ist heute die Plazierung des IABP-Katheters ein einfaches, schnelles und sicheres Verfahren geworden, wodurch der rasche Einsatz der IABP vor allem auch in Notfallsituationen mtiglich ist. Die Implantation des Ballons gelingt mit der perkutanen Technik nach Literaturangaben bei weit ª 90% der Patienten [56]; im eigenen Kollektiv war eine korrekte Plazierung sogar bei 373 von 381 konsekutiven Patienten (97,9%) m6glich [71]. Die H~iufigkeit relevanter IABP-Komplikationen, wie transfusionsbedª Blutung, Gef~igverletzung, Embolie, Infektion oder zum Abbruch der Pumpma6nahme zwingende Beinisch~imie, liegt deutlich unter 10%; sie konnte in unserer Klinik in den letzten Jahren signifikant von zunfichst 30,4% bei rein chirurgischer Implantation dickwandiger K a t h e t e r auf zuletzt 8,4% bei Verwend u n g der p e r k u t a n e n I m p l a n t a t i o n s t e c h n i k u n d dª n e r e r B a l l o n k a t h e t e r reduziert werden [71].…”

Section: Klinische Ergebnisse Der Iabp: Die Erste Klinischeunclassified

“…Die Implantation des Ballons gelingt mit der perkutanen Technik nach Literaturangaben bei weit ª 90% der Patienten [56]; im eigenen Kollektiv war eine korrekte Plazierung sogar bei 373 von 381 konsekutiven Patienten (97,9%) m6glich [71]. Die H~iufigkeit relevanter IABP-Komplikationen, wie transfusionsbedª Blutung, Gef~igverletzung, Embolie, Infektion oder zum Abbruch der Pumpma6nahme zwingende Beinisch~imie, liegt deutlich unter 10%; sie konnte in unserer Klinik in den letzten Jahren signifikant von zunfichst 30,4% bei rein chirurgischer Implantation dickwandiger K a t h e t e r auf zuletzt 8,4% bei Verwend u n g der p e r k u t a n e n I m p l a n t a t i o n s t e c h n i k u n d dª n e r e r B a l l o n k a t h e t e r reduziert werden [71]. Die Komplikationsrate ist n e b e n der Katheterdicke auch abh~ingig r o n der P u m p d a u e r .…”

Section: Klinische Ergebnisse Der Iabp: Die Erste Klinischeunclassified

“…Die Komplikationsrate ist n e b e n der Katheterdicke auch abh~ingig r o n der P u m p d a u e r . Bei kurzer P u m p d a u e r (< 48 Stunden) und V e r w e n d u n g eines 9,5-F-Katheters betrug die Komplikationsrate lediglich noch 3,9% [71]. Interessanterweise ist die Komplikationsrate der I A B P bei simultaner systemischer Lysetherapie signifikant reduziert [71].…”

Section: Klinische Ergebnisse Der Iabp: Die Erste Klinischeunclassified

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Reperfusionstherapie und mechanische Kreislauf-unterstützung bei Patienten mit kardiogenem Schock

Scholz

1999

Herz

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Cardiogenic shock is a state of inadequate tissue perfusion due to cardiac dysfunction, which is most commonly caused by acute myocardial infarction. The pathophysiology of cardiogenic shock is characterized by a downward spiral: ischemia causes myocardial dysfunction, which, in turn, augments the ischemic damage and the energetical imbalance. With conservative therapy, mortality rates for patients with cardiogenic shock are frustratingly high reaching more than 80%. Additional thrombolytic therapy has not been shown to significantly improve survival in such patients. Emergency cardiac catheterization and coronary angioplasty, however, seem to improve the outcome in shock-patients, which most probably is due to rapid and complete revascularization generally reached by angioplasty. In addition to interventional therapy with rapid coronary revascularization, the use of mechanical circulatory support may interrupt the vicious cycle in cardiogenic shock by stabilizing hemodynamics and the metabolic situation. Different cardiac assist devices are available for cardiologists and cardiac surgeons: 1. intraaortic balloon counterpulsation (IABP), 2. implantable turbine-pump (Hemopump), 3. percutaneous cardiopulmonary bypass support (CPS), 4. right heart, left heart, or biventricular assist devices placed by thoracotomy, and 5. intra- and extrathoracic total artificial hearts. Since percutaneous application is possible with IABP, Hemopump and CPS, these devices are currently used in interventional cardiology. The basic goals of the less invasive intraaortic balloon counterpulsation (IABP; Figure 1) are to stabilize circulatory collapse, to increase coronary perfusion and myocardial oxygen supply, and to decrease left ventricular workload and myocardial oxygen demand (Figure 2). Since the advent of percutaneous placement, IABP has been used by an increasing number of institutions (Figure 3). In addition to cardiogenic shock, the system may be of use in a variety of other indications in the catheterization laboratory and intensive care unit, including weaning from percutaneous cardiopulmonary bypass, in ischaemic left ventricular failure, in unstable angina, in high risk PTCA, and in prophylactic support in patients with myocardial infarction and successful revascularization. Animal experimental data showed that IABP may improve success of thrombolysis and recent clinical data suggest that survival is enhanced and transfer for revascularization is facilitated when patients with myocardial infarction and cardiogenic shock undergo thrombolysis and IABP rather than thrombolysis alone. A lot of studies had demonstrated before, that combined use of counterpulsation and revascularization therapy (i.e. coronary bypass surgery or angioplasty) may improve prognosis in patients with myocardial infarction complicated by cardiogenic shock (Table 1). In such patients, early treatment with IABP is most important: Multivariate analysis identified early IABP-support with a duration of shock to IABP-treatment of > or = 4 hours as an independ...

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Complications of intra-aortic balloon counterpulsation.The role of catheter size and duration of support in a multivariate analysis of risk

Cited by 43 publications

References 24 publications

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave

Intra-Aortic Balloon Counterpulsation in Contemporary Practice – Where Are We?

Reperfusionstherapie und mechanische Kreislauf-unterstützung bei Patienten mit kardiogenem Schock

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