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Cardiogenic shock in the setting of severe aortic stenosis: role for intra-aortic balloon pump support
  1. Olcay Aksoy1,
  2. Rayan Yousefzai2,
  3. Dhssraj Singh2,
  4. Shikhar Agarwal2,
  5. Bridget O'Brien1,
  6. Brian P Griffin1,
  7. Samir R Kapadia1,
  8. Murat E Tuzcu1,
  9. Marc S Penn1,
  10. Steven E Nissen1,
  11. Venu Menon1
  1. 1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Venu Menon, Director Coronary Intensive Care Unit, Cleveland Clinic, 9500 Euclid Avenue/J1-5, Cleveland, Ohio 44195, USA; menonv{at}ccf.org

Abstract

Objective To investigate the haemodynamic effects of intra-aortic balloon pump (IABP) support in patients with severe aortic stenosis (AS) presenting in cardiogenic shock (CS).

Design Observational cohort study.

Setting Tertiary academic centre coronary intensive care unit (CICU).

Patients Patients presenting to the CICU in CS with an established diagnosis of AS (n=25 with mean age (±SD) of 73.5±9.5 years). The peak and mean Doppler AV gradients were 67±26.8 mm Hg and 39.8±16.8 mm Hg, respectively, with a mean baseline cardiac index of 1.77±0.38 l/min/m2).

Interventions Utilisation of IABP.

Main outcome measures Haemodynamic impact of IABP over time.

Results With the insertion of an IABP, patients' cardiac index improved from 1.77 l/min/m2 to 2.18 and 2.36 l/min/m2 at 6 and 24 h, respectively (p<0.001 for both times points). Systemic vascular resistance was reduced from 1331 dyn/s/cm5 to 1265 and 1051 dyn/s/cm5 at 6 and 24 h, respectively (p=0.66 and p=0.005, respectively). The central venous pressure was reduced from 14.8 mm Hg to 13.2 and 10.9 mm Hg at 6 and 24 h, respectively (p=0.12 and p=0.03, respectively). IABP insertion was associated with a complication in 3 of the 25 cases, including a deep vein thrombosis, thrombocytopenia, limb ischaemia, and technical malfunctioning of the device.

Conclusions IABP support improves the haemodynamic profile in patients with severe AS who present in CS. IABP utilisation in this critically ill population should be strongly considered as patients are being evaluated for candidacy for advanced interventions.

  • Aortic Valve stenosis
  • Intraaortic Balloon pumping
  • haemodynamics
  • cardiogenic shock, intensive care
  • haemodynamics
  • aortic valve disease

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Cleveland Clinic Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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