title: A single center tertiary care experience utilizing the large volume mega 50cc intra-aortic balloon counterpulsation in contemporary clinical practice.
abstract: OBJECTIVE
  Clinical outcomes and adverse events utilizing the large volume 50cc intra-aortic balloon (IAB) in contemporary clinical practice.
  
  
  BACKGROUND
  The newer large volume 50cc IAB, recently introduced into clinical practice offers improved diastolic augmentation and better left ventricular (LV) unloading compared to the older 40cc IAB.
  
  
  METHODS
  In 150 consecutive patients who received intra-aortic balloon counterpulsation (IABC) with a 50cc balloon from 2011 to 2015, we retrospectively analyzed demographic, clinical, laboratory, and hemodynamic variables, adverse events and survival to discharge from index hospitalization.
  
  
  RESULTS
  Median LVEF was 20%. The most common indication was cardiogenic shock (CS) in 100 patients. Median duration of IABC was 92.5 hr. 95% of patients were free of any IAB device related complications. Five patients received a transfusion for bleeding causally related to IABC. 70 of the 150 patients who received MCS with IABC with no escalation of therapy, recovered and were discharged alive. Fifteen patients were stabilized on IABC and bridged to orthotopic heart transplant. All 15 were discharged alive. Thirty-four patients were initiated on IABC and escalated to VAD and/or Impella/Tandem Heart, with 24 patients surviving to hospital discharge. Overall survival to hospital discharge for the 150 patients was 72.7%.
  
  
  CONCLUSIONS
  IABC using a larger volume 50cc balloon appears effective as a first line percutaneous MCS strategy in a large fraction of critically ill cardiac patients with few adverse events. A large scale registry or randomized clinical trial utilizing the larger volume IAB is needed to validate our results. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Gautam K
authors.identifier: http://orcid.org/0000-0003-0891-8468
authors.initials: GK
authors.lastname: Visveswaran
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Seliem
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Michael
authors.initials: M
authors.lastname: DiVita
authors.affiliation: Division of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Jonathan K R
authors.initials: JKR
authors.lastname: McNamara
authors.affiliation: Division of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Amar
authors.initials: A
authors.lastname: Dave
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Najam
authors.initials: N
authors.lastname: Wasty
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: David A
authors.initials: DA
authors.lastname: Baran
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D004867:Equipment Design; D005260:Female; D006353:Heart-Assist Devices; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: counterpulsation; mechanical circulatory support; ventricular support