Long-term survival after counterpulsation for medically refractory heart failure complicating myocardial infarction and cardiac surgery

Intra-aortic balloon counterpulsation (IABP) was performed in225 patients over a 12-year period for the treatment of severeleft ventricular failure following acute myocardial infarctionand cardiac surgery, and which had failed to respond to conventionaltherapy. Of these patients, 97 (43%) were discharged alive fromhospital. Patients were followed-up for a mean of 5.8 years(3 months to II years) and assessment of functional status wasmade. In patients with shock after myocardial infarction, themost favourable outcome was seen in patients who had mechanicalcardiac defects which were corrected after institution of IABPand in those treated within 8 hours of the onset of shock; ofthose patients without shock, best results were seen in patientswho had evidence of continuing ischaemia prior to IABP. In patientstreated after cardiac surgery, long-term results were favourableinpatients with goodpre-operative left ventricular functionandin those who underwent coronary artery bypass grafting oraortic valve replacement. Long-term results inpatients treatedwith IABP for refractory cardiac failure are encouraging andsuggest that IABP should have a continuing role in certain highrisk patient groups.