Comparison of Percutaneous Ventricular Assist Device and Intra-Aortic Balloon Pump for Cardiogenic Shock

Abstract

Purpose Over the past decade, novel temporary percutaneous ventricular assist devices (PVAD) have emerged with active continuous flow support for the management of cardiogenic shock. The hemodynamic benefit of PVADs over the intra-aortic balloon pump (IABP) is established. However, data comparing the clinical use and outcomes of these devices have been sparse and controversial. Methods A single center, retrospective chart review was performed on adult patients who required temporary mechanical support with an IABP or PVAD (Abiomed Impella 5.0, Danvers, MA) for at least 72 hours in duration for the management of refractory, acute cardiogenic shock. These patients were adjudicated to have cardiogenic shock defined by cardiac index (CI) Results 43 patients met inclusion requirements for this study, with 28 patients receiving a PVAD and 15 patients receiving an IABP. Age, sex, ethnicity, and baseline hemodynamics were similar. Baseline serum creatinine (Cr) was higher in PVAD vs IABP (2.3 vs 1.6 mg/dL; p=0.033). Following intervention, PVAD had a higher likelihood for successful bridge to Tx/VAD compared to IABP (p=0.003). Both modalities showed similar 30-day mortality (Figure 1, p=0.26). Cardiac index improved for both PVAD and IABP. Renal function improved only after PVAD (Cr, 2.4 vs 1.8 mg/dL; p=0.02). Non-fatal bleeding was higher with PVAD. Conclusion In this single center study, PVAD was associated with more successful bridge to Tx/VAD, improved PCWP, CI and end-organ function. There was a trend towards higher survival compared to IABP albeit with a higher incidence of minor bleeding complications. Further studies are needed to distinguish the benefits of PVAD therapy.