Effectiveness of intraaortic balloon counterpulsation in the elderly

The effectiveness of intraaortic balloon counterpulsation (IABP)in the elderly was evaluated in a group of 63 patients withacute myocardial infarction (AMI) complicated by refractoryleft ventricular failure (LVF, n = 16), cardiogenic shock (CS,n = 32) or acute ventricular septal defect (VSD, n = 15). Themean age was 61 years (range: 32–78 years); 35 patientswere under and 28 over the age of 65. Failures of insertion of the IABP catheter were significantlymore frequent in the elderly (37.5 v. 11.4%, P <0.05). The rate of major complications, which was 12.7% in the wholeseries, did not significantly differ between the two age groups. Patients with medical indications for IABP (LVF, CS) had anoverall in-hospital mortality of 68.8%: no difference was observedbetween young (67.7%) and elderly (70.6%) patients. In elderlypatients with VSD, IABP was ineffective even when reparativesurgery could be performed. Haemodynamic effects of IABP were evaluated in 32 medical patientswho survived the 4th hour of treatment. All haemodynamic parametersimproved in the early phase of pumping (within 4h) except cardiacindex and total systemic resistance, which were significantlymodified after 12 and 24 h of treatment, respectively. An earlyimprovement in stroke index proved to be predictive of survival.No haemodynamic difference was found between the age groupseither in the early or in the late phase of cardiocirculatorymechanical assistance. Fifteen patients (10 CS, 3 LVF, 2 VSD) were discharged fromthe hospital and 14 were long-term survivors (more than 60 days). It was concluded that age cannot be considered as a contraindicationto IABP during complicated AMI, since the only difference betweenthe two age groups consisted in a higher rate of failure inintroducing the catheter in the elderly.