Abstract 3259: Intra-Aortic Balloon Pump Insertion Prior to LVAD Implantation Improves Short-term Survival in High-Risk LVAD Recipients

Abstract

INTRODUCTION: Intra-aortic balloon pump (IABP) insertion can augment cardiac function in the setting of acutely decompensated heart failure. The aim of this study was to determine if IABP insertion prior to left ventricular assist device (LVAD) implantation improves outcomes in LVAD recipients. HYPOTHESIS: We assessed the hypothesis that pre-operative IABP insertion for hemodynamic stability and improved organ perfusion would lead to better outcomes post-LVAD implant METHODS: We have previously described a preoperative LVAD risk score (LRS), which is based on preoperative characteristics associated with inferior outcomes after LVAD insertion (e.g. previous cardiac surgery, ventilator dependence, elevated central venous pressure, elevated prothrombin time). We retrospectively reviewed the records of 245 patients undergoing LVAD implantation (Heartmate I, Heartmate II & DeBakey) at our center between 1996 and 2006, including preoperative LRS and 30-day survival. Patients were categorized as those who received an IABP prior to LVAD implant for hemodynamic stability and those who did not. Data were analyzed by Chi-square and Mann-Whitney U tests. RESULTS: Of 245 patients having LVAD implants during the study period, 174 (71%) had a LRS of 1–5 (low-risk group), while 71 (29%) had a LRS of 6 –10 (high-risk group). A total of 95 patients received an IABP prior to LVAD insertion during this period: 54 (31%) of the low-risk patients and 41 (58%) of the high-risk patients. In the high-risk cohort, patients receiving pre-operative IABP (n = 41) had superior 30-day survival compared with patients who did not receive an IABP (n = 30) (78% vs. 57%, p < 0.05). Conversely, in the low-risk group, IABP insertion was associated with a trend toward lower 30-day survival (78% vs. 92%, p < 0.1). In the low-risk group, the rate of successful bridging to transplantation was higher in patients who did not receive pre-operative IABP support (86% vs. 69%, p < 0.01). CONCLUSION: LVAD candidates with a high LVAD risk score, a preoperative surrogate of increased perioperative risk, have improved 30-day survival if stabilized with an IABP prior to LVAD implantation.