Elective versus provisional intra-aortic balloon pumping in high-risk percutaneous transluminal coronary angioplasty

Background Elective intra-aortic balloon pump (IABP) support may reduce acute complications occurring during percutaneous coronary interventions (PCI) in patients with severe depression of the left ventricular ejection fraction (EF ≤ 30%). Methods Since February 1998, 133 consecutive patients with EF ≤30% underwent elective PCI in our institution; 61 had elective preprocedural IABP support (group A) and 72 patients had conventional PCI (group B). Jeopardy score was calculated in each patient from the coronary angiograms to quantify the myocardium at risk. Results EF was similar in the 2 groups. Jeopardy score was higher in group A (8.0 ± 2.8 vs 6.7 ± 2.4, P = .008). The other principal clinical and angiographic characteristics were similar in the 2 groups. Severe hypotension and/or shock occurred in 11 patients, all in group B (P = .001). All required urgent IABP support, and 3 eventually died. Intraprocedural major adverse cardiac and cerebral events (eg, myocardial infarction, severe hypotension and/or shock, urgent bypass surgery, stroke, and death) were higher in group B (17% vs 0%, P = .001). By stepwise logistic regression analysis, elective IABP support (odds ration [OR] 0.11 [95% CI 0.21-0.60], P = .011), jeopardy score (OR 5.37 [95% CI 1.10-8.70], P = .040), and female sex (OR 2.72 [95% CI 1.85-3.10], P = .015), were the correlates of intraprocedural events. Conclusions This study supports the potential usefulness of elective versus provisional IABP to prevent intraprocedural major adverse cardiac and cerebral events in high-risk PCI. (Am Heart J 2003;145:700-7.)     

Transbrachial intra-aortic balloon pumping for a patient with fulminant myocarditis

A 57-year-old man with acute myocarditis was transferred to our hospital from a local clinic. The patient experienced unexpected sudden cardiac arrest 16 h after admission. Mechanical cardiopulmonary support was started using percutaneous cardiopulmonary support, intra-aortic balloon pumping (IABP), continuous hemodialysis filtration, and temporary cardiac pacing with percutaneous cannulation of the femoral vessels. Hematoma developed at the IABP insertion site on the 5th day after admission. The IABP was removed, and another IABP system was inserted via the left brachial artery. The patient’s condition improved, and the IABP was removed on the 9th day after admission. The remainder of the patient’s in-hospital treatment was uneventful, and he showed near-normal left ventricular systolic function 1 year after discharge.     

Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention

Intra-aortic balloon pump (IABP) has been shown to support patients who are at high risk for percutaneous coronary interventions (PCIs) or becoming hemodynamically unstable during PCI, but the longer term outcomes of these strategies are unknown. This study investigated the outcomes of high-risk patients who received a prophylactic IABP (P-IABP) versus patients who required rescue IABP (R-IABP) because of intraprocedural complications. Clinical outcomes of 68 consecutive patients (69 procedures) who underwent high-risk PCI with P-IABP support were compared with those of 46 patients who required R-IABP. Patients who presented with cardiogenic shock or acute ST-segment elevation myocardial infarction, and those who were on mechanical ventilators were excluded. Clinical baseline characteristics were similar between groups except for more diabetics and patients with hypercholesterolemia in the P-IABP group. The procedural success was higher in the P-IABP group, with lower in-hospital mortality and major complications, than in the R-IABP group. At 6 months, the mortality and major adverse cardiac event rates were lower in the P-IABP group (8% vs 29%, p < 0.01, and 12% vs 32%, p = 0.02, respectively). Multivariate analysis showed that prophylactic insertion of an IABP is the only independent predictor of survival at 6 months. The incidence of vascular complications was low and comparable except for more major bleeding (15% vs 3%, p = 0.03) in the R-IABP group. In conclusion, patients who undergo high-risk PCI and then receive P-IABP support have favorable outcomes compared with those who require R-IABP for intraprocedural complications. Therefore, in high-risk patients undergoing PCI, liberal use of a P-IABP should be considered.     

Clinical significance of intra-aortic balloon pumping on no-reflow phenomenon of primary percutaneous coronary intervention for acute myocardial infarction

Background Percutaneous coronary intervention(PCI) is used as a treatment for acute myocardial infarction(AMI),and one of its major complications is the angiographic no-reflow phenomenon(NR).Although intra-aortic balloon pumping(IABP) is sometimes used in such patients to increase the diastolic coronary blood flow,there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon.Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 a...     

Transbrachial insertion of an intra-aortic balloon pump for complex coronary angioplasty.

Transfemoral insertion of intra-aortic balloon pump (IABP) for hemodynamic support is a useful adjunct in patients undergoing complex percutaneous revascularization procedures. However, this approach is not always possible, particularly in patients with severe occlusive peripheral vascular disease. We describe the first reported case of insertion of IABP through the brachial artery.     

Improvement in hemodynamics with a new, larger-volume (50 cc) intra-aortic balloon for high-risk percutaneous coronary intervention

A primary cause of adverse outcomes among high-risk patients undergoing percutaneous coronary intervention (PCI) may be a diminished capacity to tolerate the hemodynamic and ischemic insults that can occur during the procedure. A common means of mechanical support during PCI has been the intra-aortic balloon pump (IABP). We describe successful periprocedural mechanical support with a new, 50 cc IABP in a patient with both severe left ventricular dysfunction and extensive coronary arteriosclerosis, for whom PCI with stenting was indicated. The prophylactic use of this 50 cc IABP, which traditionally would be contraindicated because of the patient's height (162.6 cm), markedly increased the diastolic aortic pressure (by approximately 110 mmHg) over the baseline level, while promptly reducing left-sided heart pressures. This finding appears to exceed the average diastolic augmentation reported for smaller-volume balloons. Although the role of the IABP in high-risk PCI remains controversial, further research is warranted to clarify and compare this new 50 cc IABP to smaller-volume balloons, and ascertain whether the observed hemodynamic benefits can translate into improved clinical outcomes among patients requiring mechanical support during PCI.     

Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: Vascular complications and incidence of bleeding

Objective: Compare vascular complications and incidence of bleeding of Impella 2.5 and intra-aortic balloon pump (IABP) in high-risk percutaneous coronary interventions (PCI).

Background: Large arterial sheath size for device insertion is associated with vascular and/or bleeding complications; gastrointestinal bleeding may also occur with anti-coagulation use.

Methods: Patients with an acute coronary syndrome receiving Impella 2.5 or IABP during high-risk PCI were studied (13 Impella; 62 IABP). Vascular complications and incidence of bleeding were compared.

Results: Post-procedure hematocrit was similar between groups. Blood transfusion occurred in 38.4% and 32.2% of patients in the Impella and IABP groups, respectively (P = NS); 65.3%, 30.7% and 3.8% of bleeding were due to vascular access site/procedure related, gastrointestinal and genitourinary, respectively. There was no statistical significant difference in vascular complications between the Impella and IABP groups (15.3% and 6.4% of patients, respectively); mesenteric ischemia (n = 1) and aortic rupture (n = 1) were only in the IABP group. In-hospital and one-year mortality were not statistically significant between groups.

Conclusion: Impella can be used as safely as IABP during high-risk PCI with similar vascular and bleeding complications. Importantly, approximately one third of bleeding was from the gastrointestinal system warranting careful prophylactic measures and monitoring.     

高危复杂冠脉病变经皮冠状动脉介入术前保护性置入主动脉内球囊反搏的临床观察

目的:探讨高危复杂冠脉病变患者经皮冠状动脉介入术(PCI)前保护性置入主动脉内球囊反搏(IABP)对围手术期临床疗效的影响。方法:回顾性分析高危复杂冠脉病变的患者190例,其中PCI术前保护性置入IABP的79例为观察组,其余111例没有预先置入IABP或术中病情变化紧急被动置入IABP的患者为对照组。比较2组术中、术后及临床转归情况。结果:观察组中仅1例患者术后IABP持续携带3 d拔除,其余均术后即刻拔除;观察组患者均能耐受手术,术后无急性、亚急性血栓,无心力衰竭发生,无1例死亡。观察组入路并发症的发生率以及血红蛋白下降水平明显高于对照组(均P0.05)。对照组有3例术中突发急性左心衰,1例发生冠脉严重无复流,从而被动置入IABP,此3例患者中1例因心原性休克抢救无效死亡,2例IABP持续携带5 d后拔除。结论:高危复杂冠脉病变介入治疗中,保护性预置入IABP能明显提高患者的手术耐受性和手术成功率,减少PCI术中并发症,降低围手术期不良事件。     

主动脉内球囊反搏治疗急性心肌梗死急诊冠状动脉介入治疗术后无复流现象的临床研究

目的:探讨主动脉内球囊反搏(IABP)在急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)术后无复流(NR)现象中的治疗作用.方法:分析自2006-01-2010-08期间因AMI行PCI术后NR患者30例资料,采用单双日法分组方法将其中16例运用 IABP治疗,其余未用IABP的14例为对照组,观察术后10 d内心肌损伤标志物、脑钠肽(BNP)及血管活性物质恢复情况.心肌损伤标志物包括肌红蛋白、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI);血管活性物质指标包括肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、肾上腺素(E)、去甲肾上腺素(NE);治疗10 d后应用彩色超声心动图测量患者左房内径、左室内径、左室射血分数(LVEF);并随访3个月、6个月左房内径、左室内径、LVEF变化情况.结果:IABP治疗组患者血管活性物质及心肌损伤标志物指标时间-浓度曲线显示指标下降明显快于对照组,2组间血管活性物质及心肌损伤标志物与对照组相比,2组下降幅度差异有统计学意义(P<0.05);IABP组BNP峰值较对照组提前,IABP治疗组BNP指标时间-浓度曲线显示指标下降明显快于对照组,2组间BNP指标下降与对照组相比差异无统计学意义(P>0.05);超声心动图测量2组患者10 d、3个月及6个月时左房内径、左室内径及LVEF差异有统计学意义(P<0.05).结论:IABP能够加速降低AMI急诊PCI术后发生NR患者升高的交感神经系统、RAS系统激素及心肌损伤标志物的水平;使BNP峰值提前并改善10 d、3个月及6个月时左房内径、左室内径及射血分数值.     

Bilateral arm approach for percutaneous coronary intervention of unprotected left main supported by a modified intra-aortic balloon pump

Patients in whom femoral arterial access is not feasible pose a challenge in terms of hemodynamic support during high-risk percutaneous coronary intervention. Patient's height adds another challenge given the fixed lengths of available intra-aortic balloon pumps, in terms of achieving an adequate infrasubclavian positioning in the descending thoracic aorta. We report a case where a modified intra-aortic balloon pump helped achieve a successful result in a patient undergoing intervention of an unprotected left main using bilateral arm approach.     

Thrombocytopenia in patients of acute coronary syndrome with intra-aortic balloon pumping placement

Background Thrombocytopenia is a common complication of IABP. Until now,there is no unified conclusions about the incidence,characteristics,risk factors and the prognosis of IABP related thrombocytopenia.Methods In this study,the data of patients with ACS undergoing PCI and IABP were retrospectively analyzed.All enrolled patients were divided into thrombocytopenia group and non-thrombocytopenia group according to the occurrence of thrombocytopenia after insertion of IABP. The baseline data of the two groups were compared,and the possible risk factors of thrombocytopenia and their impact on prognosis were analyzed by chi-square test and logistic regression analysis. Results Sixty-two patients were enrolled in this study. The rate ofIABP associated thrombocytopenia was 25.8%(16/62)of all patients. Older agewas an independent risk factor of IABP associated thrombocytopenia(OR:3.625;95% confidence interval:1.016-12.935;P=0.047). The incidence of TIMI bleeding events was higher in thrombocytopenia group[75.0%(12/16)vs. 43.5%(20/46),P=0.042]. The rate of in-hospital death was similar between the two groups[18.8%(3/16)vs. 17.4%(8/46),P=1.0]. Conclusion IABP associated thrombocytopenia occurs in 25.8% of patients with ACS undergoing PCI and correlates with increased TIMI bleeding events. Older age may predict IABP associated thrombocytopenia.     

Efficacy of intra-aortic balloon pumping for failing Fontan circulation

The Fontan circulation occasionally cannot be sustained by currently available medical treatment. In these circumstances, mechanical assistance to the Fontan circulation should be considered. We have experienced three cases where Fontan circulation was assisted by intra-aortic balloon pumping (IABP). The hemodynamic improvement and weaning from IABP were successfully achieved in all cases. One patient survived the serious postoperative course with the aid of IAPB, and two patients died following multiorgan failure, though the circulation had eventually been re-established. By studying the postoperative hemodynamics assisted by IABP, it is concluded that IABP is a reasonable, efficacious strategy to support and to re-establish the failing Fontan circulation, though the changes in hemodynamic variables will not immediately coincide with IABP application.     

冠心病危重症患者应用主动脉球囊反搏术的护理干预

目的探讨主动脉球囊反搏术（）治疗冠心病危重症患者的护理体会。方法纳入年月～2012年2月应用IABP治疗的冠心病危重患者18例其中急性心肌梗死伴心源性休克5例、急性心肌梗死急诊PCI术5例,冠心病复杂病变介入治疗保护性使用8例,回顾分析其临床资料,总结IABP治疗前后的护理经验。结果应用IABP治疗过程中,共发生不良反应15例（83.3%）,4例出现出血并发症,2例球囊导管移位,电极片接触不良9例。由于监测密切治疗护理恰当,均及时缓解,未出现严重并发症。结论在做好IABP患者心理护理及对医护人员岗前培训,重视凝血指标监测、心电监测、压力监测、体位护理、熟悉报警系统、保证传感压力腔通畅等护理措施,可及时发现和减少各种并发症,提高危重症冠心病患者的抢救成功率。     

主动脉内球囊反搏辅助老年急性冠脉综合征患者介入治疗临床疗效分析

目的评价老年急性冠脉综合征(ACS)患者在主动脉内球囊反搏(IABP)辅助下进行介入治疗的临床疗效及安全性。方法回顾性分析160例ACS患者在IABP辅助下行介入治疗的临床资料,按年龄分为两组:中青年组(年龄<60岁)58例,老年组(年龄≥60岁)102例。对两组的手术成功率、住院期间不良事件及IABP相关并发症进行对比分析。结果两组手术成功率分别为98.3%,97.1%;院内存活率分别为89.7%,83.3%;IABP相关并发症发生率分别为3.4%,5.9%。上述差异均无统计学意义(P>0.05)。结论IABP辅助介入治疗老年ACS患者具有与中青年ACS患者应用时相似的临床疗效及安全性。