Intra aortic ballon pumping in myocardial infarction and unstable angina

Abstract

From 1972 to 1979 intra aortic balloon pumping (IABP) was attempted in 181 patients; catheter insertion failed in 13 (8%). More complications occurred with prolonged treatment but all three lethal complications (2%) were related to catheter insertion. Seventy-six patients had clinical cardiogenic shock after myocardial infarction (CSM1). Haemodynamically, 23 were classified as preshock: 15 (66%) could be weaned, 12 (53%) survived over 3 months; whereas only 27/51 patients (51%) haemodynamically classified as shock could be weaned and 21 (40%) survived over 3 months. Of forty-two patients with refractory angina at rest, 41 had prompt relief of pain after IABP, and subsequently underwent coronary artery bypasss grafting (CABG). Perioperative infarction rate was 8% (4/41), perioperative mortality was 7% (3/41). Total infarction rate was 11% (5/42), and total mortality 7% (3/41). Pain relief was prompt in 14/17 patients (82%) with refractory angina after infarction. Pain persisted in three patients: all three sustained an infarction, one died. Two patients were excluded from surgery. Twelve patients underwent CABG; none died, none developed MI. In eight patients persistence of pain suggested a slowly evolving MI, IABP abolished pain in seven. Conclusion: IABP has demonstrated its efficacy both in pump failure and in refractory ischaemia. However, its use is not without risks. The effect of intra aortic balloon pumping (IABP) is which is related to myocardial oxygen consumptwofold!'!. The abrupt presystolic balloon deflation tiont 1 ' 4 ! is termed the endocardial viability ratio decreases afterload, while the post systolic balloon (EVR)t'l. EVR has been regarded a reflection inflation enhances coronary perfusion pressure, of this balance between oxygen availability and which is the major determinant of coronary blood consumption, flow in the presence of critical stenosis! 2 " 3 L The clinical use of IABP has been advocated for Reduction of afterload increases stroke volume cardiogenic shock following acute myocardial inand ejection fraction, and decreases wall tension farction (CSMI) and severe left ventricular failure and preload, and thus oxygen consumption. It has (LVF) after acute infarction! 5-14 1, with and without even been suggested, that counterpulsation may mechanical defects, for angina pectoris at rest open dormant collateral channelsl'l, and that IABP completely refractory to medical therapy! 15-16 1, for increases flow to the subendocardium by augment-severe LVF and cardiopulmonary bypass depening existing collateral circulation!'!. dence following open heart surgery!' 7 !, for LVF of Afterload reduction reduces oxygen demand; varying aetiological background!' 8 !, for life threatdiastolic augmentation increases oxygen avail-ening cardiac arrhythmias refractory to antiarrhyability. The ratio of the Diastolic Pressure Time thmic therapy, and as a supportive measure Index (DPTI) representing myocardial blood in critically ill cardiac patients undergoing major flow!'!, and the Systolic Time Tension Index (...

Intra-aortic balloon pump counterpulsation: are we optimizing the management of cardiogenic shock?

“…Technological advancement has led to the availability of a percutaneous insertable IABP which interventional cardiologists began to test in high-risk PCI patients. In 1980, Michels et al 5 conducted a cohort study of 181 patients with either cardiogenic shock post-myocardial infarction (MI) or unstable angina. Of the patients with unstable angina, 42 received haemodynamic stabilization, and despite initially being deemed unfit for surgery, went on to be successfully re-vascularized by CABG.…”