RT Journal Article
SR Electronic
T1 Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 838
OP 843
DO 10.1136/hrt.2010.206367
VO 97
IS 10
A1 Olcay Aksoy
A1 Rayan Yousefzai
A1 Dhssraj Singh
A1 Shikhar Agarwal
A1 Bridget O'Brien
A1 Brian P Griffin
A1 Samir R Kapadia
A1 Murat E Tuzcu
A1 Marc S Penn
A1 Steven E Nissen
A1 Venu Menon
YR 2011
UL http://heart.bmj.com/content/97/10/838.abstract
AB 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.