IABP: history-evolution-pathophysiology-indications: what we need to know.

H Parissis,G Hooks,P C Mhandu,V Graham,M Lau,S Lampridis

doi:10.1186/s13019-016-0513-0

H Parissis, G Hooks + Show 4 more

Open Access

https://doi.org/10.1186/s13019-016-0513-0

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Abstract

Treatment with the intraaortic balloon pump (IABP) is the most common form of mechanical support for the failing heart. Augmentation of diastolic pressure during balloon inflation contributes to the coronary circulation and the presystolic deflation of the balloon reduces the resistance to systolic output. Consequently, the myocardial work is reduced. The overall effect of the IABP therapy is an increase in the myocardial oxygen supply/demand ratio and thus in endocardial viability.This is an overall synopsis of what we need to know regarding IABP. Furthermore, this review article attempts to systematically delineate the pathophysiology linked with the hemodynamic consequences of IABP therapy. The authors also look at the future of the use of the balloon pump and conclude that the positive multi-systemic hemodynamic regulation during IABP treatment should further justify its use.

Highlights

Different forms of support of the failing heart consist of Cardiopulmonary Bypass Pumps/ extracorporeal membrane oxygenation (ECMO), internal or external Counterpulsation and the various modes of Auxiliary heart pump.Intraaortic balloon pump (IABP) is a form of internal counterpulsation, acting as an assisting circulatory support device
Inability to be weaned off cardiopulmonary bypass/post cardiotomy cardiogenic shock As early as the beginning of 1970s Berger et al [92] and Goldman and colleagues [93] realized that a major indication for use of an intra-aortic balloon pump is cardiac dysfunction with low cardiac output after heart surgery
To summarise, the use of the intraaortic balloon pump (IABP) is justified because an increase in diastolic pressure during balloon inflation augments the coronary circulation

Summary

Introduction

Different forms of support of the failing heart consist of Cardiopulmonary Bypass Pumps/ ECMOs, internal or external Counterpulsation and the various modes of Auxiliary heart pump.Intraaortic balloon pump (IABP) is a form of internal counterpulsation, acting as an assisting circulatory support device. Buckley et al [9] looked at the hemodynamic benefit of the IABP and reported the results of treating the first eight patients in cardiogenic shock and confirmed that balloon inflation in diastole augments coronary perfusion and deflation just before systole markedly reduces resistance to the left ventricular ejection and thereby reduces cardiac work and myocardial oxygen consumption.

Results

Conclusion