Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

Background

The use of aortic counterpulsation therapy in advanced heart failure iscontroversial.

Objectives

To evaluate the hemodynamic and metabolic effects of intra-aorticballoon pump (IABP) and its impact on 30-day mortality in patientswith heart failure.

Methods

Historical prospective, unicentric study to evaluate all patientstreated with IABP betwen August/2008 and July/2013, included in aninstitutional registry named TBRIDGE (The Brazilian Registry ofIntra-aortic balloon pump in Decompensated heart failure - GlobalEvaluation). We analyzed changes in oxygen central venous saturation(ScvO₂), arterial lactate, and use of vasoactive drugsat 48 hours after IABP insertion. The 30-day mortality was estimatedby the Kaplan-Meier method and diferences in subgroups were evaluatedby the Log-rank test.

Results

A total of 223 patients (mean age 49 ± 14 years) were included.Mean left ventricle ejection fraction was 24 ± 10%, and 30% ofpatients had Chagas disease. Compared with pre-IABP insertion, weobserved an increase in ScvO₂ (50.5% vs. 65.5%, p <0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and adecrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and useof vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion.Thirty-day survival was 69%, with lower mortality in Chagas diseasepatients compared without the disease (p = 0.008).

Conclusion

After 48 hours of use, IABP promoted changes in the use of vasoactivedrugs, improved tissue perfusion. Chagas etiology was associated withlower 30-day mortality. Aortic counterpulsation therapy is aneffective method of circulatory support for patients waiting for hearttransplantation.