High Risk Percutaneous Coronary Intervention and Intra-Aortic Balloon Pumps

Abstract

The goal of percutaneous coronary intervention (PCI) is to decrease the coronary obstruction in a durable manner without compromising or damaging the myocardium so that patients may obtain the clinical benefits from the procedure, namely potentially improved survival in the setting of acute myocardial infarction interventions and improvement in health status for elective interventions. Interventional cardiologists make decisions each day aimed at improving the likelihood of both procedural success and resultant patient outcomes. These wide-ranging decisions include procedural planning, adjunctive pharmacotherapy, and device therapy for both coronary devices and possible use of various hemodynamic support devices. It is in this framework that the effectiveness of intra-aortic balloon pump (IABP) counterpulsation devices must be considered because they represent a common tool that interventional cardiologists use for procedure and patient support. Article see p 21 IABP counterpulsation was first reported in 1968 as a cardiac-assist device in a patient with cardiogenic shock,1 which supported the patient as shock resolved. As an adjunctive hemodynamic support device, the intra-aortic balloon is timed with the cardiac cycle to inflate at the start of diastole, augmenting diastolic pressure, which increases coronary perfusion and oxygen delivery to the myocardium. It is timed to deflate just before the start of systole, thereby reducing afterload. This facilitates ejection of blood from the left ventricle (LV) by decreasing LV work and reducing myocardial oxygen demands,2 resulting in increased cardiac output. …