CHANGING TRENDS IN INTRA-AORTIC BALLOONPUMP SUPPORT.

D. De Bock, W. Vergauwen, J. Liesmons, I. Rodrigus

UZ Antwerpen, Edegem

Objective : The intra-aortic balloon pump (IABP) use continues to expand. There still exists a variation in utilization over time and across different centers, creating the need to document the current clinical experience and indications for IABP.
We evaluated the temporal shift in indications for IABP use.

Methods : We retrospectively analyzed 651 patients receiving IABP between 1993 and 2001.
Patients were randomized in 3 groups: group 1 (n=163) received prophylactic IABP support before cardiac surgery; group 2 (n=264) received peroperative IABP support and in group 3 (n=224) IABP was used in a cardiological setting, without immediate operation.
Complications, length of IABP support and mortality are compared.

Results : Despite an optimized pharmacological treatment there is an increasing use of IABP (from 49 patients in 1993 to 109 patients in 2001). The percent distribution of IABP use in group 1, 2 and 3 in 1993 and 2001 is 32.6%, 45%, 22,4%  and 31,2%, 29,4%, 39,4%, coinciding with a high increase in percutaneous coronary interventions (PCI) and a downward slope in surgical procedures.
More elderly patients (>80 years of age) and patients with multiple risk factors were treated over the years.
Insertion modality, complication rate, length of IABP support and mortality are presented in table 1.

TABLE 1. Insertion modality, complication rate, length of IABP support and mortality.

Conclusions : There is an increasing trend in the use of IABP due to a wider range of cardiological indications and percutaneous coronary interventions. In this cardiological group IABP is mostly placed percutaneously, resulting in more complications and a higher mortality rate.
Prophylactic IABP treatment before surgery is gaining interest, while the expected decrease in the peroperative IABP use was not seen.