Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support.
OBJECTIVE
To investigate the haemodynamic effects of intra-aortic balloon pump (IABP) support in patients with severe aortic stenosis (AS) presenting in cardiogenic shock (CS).


METHODS
Observational cohort study. Setting Tertiary academic centre coronary intensive care unit (CICU). Patients Patients presenting to the CICU in CS with an established diagnosis of AS (n=25 with mean age (± SD) of 73.5 ± 9.5 years). The peak and mean Doppler AV gradients were 67 ± 26.8 mm Hg and 39.8 ± 16.8 mm Hg, respectively, with a mean baseline cardiac index of 1.77 ± 0.38 l/min/m²). Interventions Utilisation of IABP. Main outcome measures Haemodynamic impact of IABP over time.


RESULTS
With the insertion of an IABP, patients' cardiac index improved from 1.77 l/min/m² to 2.18 and 2.36 l/min/m² at 6 and 24 h, respectively (p<0.001 for both times points). Systemic vascular resistance was reduced from 1331 dyn/s/cm⁵ to 1265 and 1051 dyn/s/cm⁵ at 6 and 24 h, respectively (p=0.66 and p=0.005, respectively). The central venous pressure was reduced from 14.8 mm Hg to 13.2 and 10.9 mm Hg at 6 and 24 h, respectively (p=0.12 and p=0.03, respectively). IABP insertion was associated with a complication in 3 of the 25 cases, including a deep vein thrombosis, thrombocytopenia, limb ischaemia, and technical malfunctioning of the device.


CONCLUSIONS
IABP support improves the haemodynamic profile in patients with severe AS who present in CS. IABP utilisation in this critically ill population should be strongly considered as patients are being evaluated for candidacy for advanced interventions.
Department of Cardiovascu Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Olcay
O
Aksoy
Rayan
R
Yousefzai
Dhssraj
D
Singh
Shikhar
S
Agarwal
Bridget
B
O'Brien
Brian P
BP
Griffin
Samir R
SR
Kapadia
Murat E
ME
Tuzcu
Marc S
MS
Penn
Steven E
SE
Nissen
Venu
V
Menon
D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology