Abstract
Over 40,000 intra-aortic balloon counterpulsation pumps (IABPs) are implanted in the United States annually. We explored the hemodynamic effect of large capacity (50cc) IABPs in patients with advanced heart failure. Methods: We conducted a prospective, observational study in 10 consecutive patients with Stage D, NYHA Class 3 or 4, non-ischemic heart failure referred for non-emergent IABP placement. Left ventricular (LV) hemodynamics were recorded for 10 minutes using a conductance catheter (CD Leycom; Figure) before and after activation of a 50cc IABP (Maquet Inc). Next, the 50cc IABP was halted for 10 minutes and a 10cc gas-extension tube inserted into the driveline to reduce the displacement volume to 40cc. LV hemodynamics were again recorded for 10 minutes before and after 40cc-IABP activation. Results: Mean age of the study population was 58±14 with an LV ejection fraction of 15±8%. The 50cc IABP reduced LV stroke work (LVSW: 1666±760 vs 1260±774 mmHg x mL, p<0.01), end-systolic pressure (LVESP: 89±24 vs 75±23 mmHg, p<0.05), and dP/dt max (868±225 vs 744±220 mmHg/sec, p<0.01). The IABP with 40cc of volume displacement reduced LVSW (1717±814 vs 1424±703, p<0.05), LVESP (94±19 vs 84±20, p<0.05), and dP/dt max (890±171 vs 810±179, p<0.01). Both 50cc and 40cc settings increased aortic diastolic pressures and reduced systolic pressures to similar degrees. Neither 50cc nor 40cc of volume displacement altered arterial elastance, LV volumes, or end-diastolic pressures (Figure). No hemodynamic differences between 50cc and 40cc of volume displacement were observed. Conclusions: This is the first study of large capacity IABPs using conductance catheters in patients with advanced heart failure. Both 50cc and 40cc volume displacement balloons reduced LV stroke work primarily by reducing LV end-systolic pressure with minimal effect on LV volumes. The clinical utility of IABPs in heart failure requires further study.
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