Preoperative use of intra-aortic balloon pump before left ventricular assist device implantation.

BACKGROUND

Intra-aortic balloon pumps (IABPs) have been employed to stabilize patients with acute-on-chronic cardiogenic shock. The use of IABP to optimize patients for successful left ventricular assist device (LVAD) implantation has not been well-studied.

METHODS

This is a single-center retrospective cohort of adults (>18 years) undergoing durable LVAD implantation between April 2011 and June 2019. One-to-one propensity matching paired patients requiring preoperative IABP placement with those who did not. The primary outcome assessed was 1-year mortality, with secondary outcomes, including hospital and intensive care unit (ICU), length of stay (LOS), duration of mechanical ventilation, and complications. Further analysis examined postoperative changes in systolic pulmonary artery pressure (PAP), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP).

RESULTS

Among 189 patients, preoperative IABP was used in 53 patients (28.0%). Of these, 32 patients were matched to 32 patients not requiring preoperative IABP placement. One-year mortality was not significantly different between IABP and non-IABP groups (17.0 vs 12.5%,  = 0.422). After matching, there were no significant differences in hospital LOS, ICU LOS, hours of postoperative mechanical ventilation, or complications including stroke, requirement for new renal replacement therapy, right heart failure, hemorrhagic complication, or infection requiring antibiotics. From the time of admission to within 24 hours prior to LVAD implantation, patients supported with IABP had greater reductions in systolic PAP and PCWP, and larger increases in CI.

CONCLUSIONS

In our study, patients requiring IABP support for stabilization undergoing durable LVAD implant had similar 1-year survival to those not requiring IABP support. Patients supported on IABP had larger reductions in PCWP and sPAP with greater increases in CI prior to LVAD implant.