Review patient case studies demonstating the benefits of IABC therapy.
Catalin Boiangiu, MD, Fellow, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ; and Marc Cohen, MD, Chief, Division of Cardiology; Director, Cardiol- ogy Fellowship, Newark Beth Israel Medical Center, Newark, New Jersey and Professor of Medicine, Mount Sinai School of Medicine, New York, New York
Abstract: We report the enhanced augmentation of cardiac output in a 60-year-old man who underwent percutaneous coronary intervention with drug-eluting stent implantation for a large anteroseptal ST-segment-elevation myocardial infarction. Because of persistent systemic hypotension during the procedure, a 50cc, 8Fr. MEGA® intra-aortic balloon was inserted, used for 24 hours, and removed without complications. The use of this new balloon — with larger blood volume displacement but smaller caliber at the insertion site — significantly increased cardiac output in 1:1, 1:2, and 1:3 assist modes, by more than 15%, 9%, and 4%, respectively. These findings exceed the average augmentations reported for smaller-volume balloon catheters.
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Pradeep K. Nair, MD, Sun Scolieri, MD, Ashley B. Lee, MD
Abstract: A primary cause of adverse outcomes among high-risk patients undergoing percutaneous coronary intervention (PCI) may be a diminished capacity to tolerate the hemodynamic and ischemic insults that can occur during the procedure. A common means of mechanical support during PCI has been the intra-aortic balloon pump (IABP). We describe successful periprocedural mechanical support with a new, 50cc IABP in a patient with both severe left ventricular dysfunction and extensive coronary arteriosclerosis, for whom PCI with stenting was indicated. The prophylactic use of this 50cc IABP, which traditionally would be contraindicated because of the patient’s height (162.6 cm), markedly increased the diastolic aortic pressure (by ~110 mmHg) over the baseline level, while promptly reducing left-sided heart pressures. This finding appears to exceed the average diastolic augmentation reported for smaller-volume balloons. Although the role of the IABP in high-risk PCI remains controversial, further research is warranted to clarify and compare this new 50cc IABP to smaller-volume balloons, and ascertain whether the observed hemodynamic benefits can translate into improved clinical outcomes among patients requiring mechanical support during PCI.
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