Current status of circulatory support with an intra-aortic balloon pump.

Although the initial clinical application of IABP was for the purpose of support of circulation in cardiogenic shock, its indications have expanded and include prophylactic use, especially in patients with ischemic heart disease. Controversy exists regarding the efficacy of this device in these conditions. Prolonged balloon support for periods of more than 5 days is presently employed in patients with chronic heart failure undergoing cardiac surgery, without concern for so-called "balloon dependence." In recent years, the incidence of use of IABP has declined markedly mainly because of comparable effects obtained by hemodynamic treatment with various drugs aimed at altering a specific parameter of cardiac function. Percutaneous application of an intra-aortic balloon catheter, although associated with a higher complication rate, has brought to clinical practice a rapid method for utilization of this device under fluoroscopic control. Because of an appreciable number of complications, however, balloon assist should be used for very specific clinical conditions.