AB 1/03 Non-Coronary Intervention Circulatory Support Advanced Angioplasty 2003 Andreas Baumbach Bristol Royal Infirmary AB 1/03 Circulatory Support PCI / Acute MI Cardiogenic shock Cardiac Surgery High risk CABG Weaning Bridge to transplant Chronic Heart Failure ? AB 1/03 Circulatory Support Balloon Counterpulsation Results & Evidence Guidelines Assist Devices: Developments AB 1/03 Intra-Aortic Balloon Pump Inflatable cc balloon Triggered to inflate with helium immediately after aortic valve closure Triggered to deflate with opening of the aortic valve AB 1/03 Intra-Aortic Balloon Pump AB 1/03 Intra-Aortic Balloon Pump Decreases Afterload Increases Diastolic Aortic Pressure Increases Coronary Flow Velocity Reduces Myocardial Oxygen Demand AB 1/03 Circulatory Support Balloon Counterpulsation Results & Evidence Guidelines Assist Devices: Developments AB 1/03 Intra-Aortic Balloon Pump Current Practice Results from the Benchmark Registry Ferguson et al. J Am Coll Cardiol 2001; 38:1456 AB 1/03 Benchmark Registry June 96-August Hospitals (90%US) patient case records Verified by external audit Ferguson et al. J Am Coll Cardiol 2001; 38:1456 AB 1/03 Benchmark Registry: Indication Hemodynamic support during/after catheterisation 20.6% Cardiogenic shock18.8% Weaning from CP bypass16.1% Preoperative use in high risk pts13% Refractory unstable angina12.3% Ferguson et al. J Am Coll Cardiol 2001; 38:1456 AB 1/03 Benchmark Registry: Complications Major: Limb ischemia, severe bleeding, balloon leak, death due to IABP2.6% In hospital mortality21.2% Failed IABP insertion2.3% Increased risk for major complications: Women Low BSA Older patients PVD Ferguson et al. J Am Coll Cardiol 2001; 38:1456 AB 1/03 IABP Evidence A prospective randomized evaluation of prophylactic intraaortic balloon counterpulsation in high risk patients with acute MI treated with primary angioplasty Stone et al. J Am Coll Cardiol 1997 AB 1/03 IABP in direct angioplasty Hypothesis: routine use of IABP after primary PCI reduces infarct related artery reocclusion Multicentre, randomised trial High risk patients randomised to 36 to 48hrs IABP or standard care Stone et al. J Am Coll Cardiol 1997 AB 1/03 IABP in direct angioplasty High risk Age>70yrs 3 vessel disease LVEF